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Marino M, Boccolini G, Tombolini P, Tiberi V, Iannilli A, Santarelli S, Gasparini F, Carciofi A, Capogna A, Cherubini V. A proposal for breakfast to improve the postprandial glucose response in children with type 1 diabetes - Preliminary results from a camp-based study. Diabetes Res Clin Pract 2024:111881. [PMID: 39368490 DOI: 10.1016/j.diabres.2024.111881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 09/13/2024] [Accepted: 10/01/2024] [Indexed: 10/07/2024]
Abstract
This study aimed to evaluate post - prandial glucose response (PPGR) after a traditional Italian breakfast and an alternative meal in children with type 1 diabetes (T1D). Preliminary findings showed that by replacing a small portion ofcarbohydrates with fats helpsimprovingPPGR after breakfast in children with T1D.
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Affiliation(s)
- Monica Marino
- Pediatric Diabetology Unit, Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria delle Marche G. Salesi Hospital, 60123 Ancona, Italy.
| | - Giada Boccolini
- Pediatric Diabetology Unit, Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria delle Marche G. Salesi Hospital, 60123 Ancona, Italy
| | - Patrizio Tombolini
- Pediatric Diabetology Unit, Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria delle Marche G. Salesi Hospital, 60123 Ancona, Italy
| | - Valentina Tiberi
- Pediatric Diabetology Unit, Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria delle Marche G. Salesi Hospital, 60123 Ancona, Italy
| | - Antonio Iannilli
- Pediatric Diabetology Unit, Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria delle Marche G. Salesi Hospital, 60123 Ancona, Italy
| | - Sara Santarelli
- Department of Pediatrics, Women's and Children's Health, Azienda Ospedaliero-Universitaria delle Marche, Salesi Hospital, 60121 Ancona, Italy
| | - Francesco Gasparini
- Department of Pediatrics, Women's and Children's Health, Azienda Ospedaliero-Universitaria delle Marche, Salesi Hospital, 60121 Ancona, Italy
| | - Annalisa Carciofi
- Department of Pediatrics, Women's and Children's Health, Azienda Ospedaliero-Universitaria delle Marche, Salesi Hospital, 60121 Ancona, Italy
| | - Antonia Capogna
- Pediatric Diabetology Unit, Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria delle Marche G. Salesi Hospital, 60123 Ancona, Italy
| | - Valentino Cherubini
- Pediatric Diabetology Unit, Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria delle Marche G. Salesi Hospital, 60123 Ancona, Italy
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2
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Mameli C, Smylie GM, Marigliano M, Zagaroli L, Mancioppi V, Maffeis C, Salpietro V, Zuccotti G, Delvecchio M. Safety and Psychological Outcomes of Tandem t:Slim X2 Insulin Pump with Control-IQ Technology in Children, Adolescents, and Young Adults with Type 1 Diabetes: A Systematic Review. Diabetes Ther 2024; 15:2133-2149. [PMID: 39008237 PMCID: PMC11411026 DOI: 10.1007/s13300-024-01618-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
The Tandem t:slim X2 insulin pump is a second-generation automated insulin delivery system with Control-IQ technology. It consists of an X2 insulin pump, an integrated Dexcom sensor, and an embedded 'Control-IQ' algorithm, which predicts glucose levels 30 min in the future, adapting the programmed basal insulin rates to get glucose levels between 112.5 and 160 mg/dl (8.9 mmol/l). The system delivers automatic correction boluses of insulin when glucose levels are predicted to rise > 180 mg/dl (10 mmol/l). It has been commercially available since 2016. We reviewed the current evidence about the psychological, safety, and exercise-related outcomes of this device in children, adolescents, and young adults living with type 1 diabetes. We screened 552 papers, but only 21 manuscripts were included in this review. Fear of hypoglycemia is significantly reduced in young people with diabetes and their parents. Interestingly, diabetes-related distress is decreased; thus, the system is well accepted by the users. The sleeping quality of subjects living with diabetes and their caregivers is improved to a lesser extent as well. Despite the small number of data, this system is associated with a low rate of exercise-related hypoglycemia. Finally, evidence from the literature shows that this system is safe and effective in improving psychological personal outcomes. Even if further steps toward the fully closed loop are still mandatory, this second-generation automated insulin delivery system reduces the burden of diabetes. It properly addresses most psychological issues in children, adolescents, and young adults with type 1 diabetes mellitus; thus, it appears to be well accepted.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, Università Di Milano, Milan, Italy
| | | | - Marco Marigliano
- Department of Surgery, Dentistry, Pediatrics, and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona, Italy
| | - Luca Zagaroli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Valentina Mancioppi
- Department of Surgery, Dentistry, Pediatrics, and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics, and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona, Italy
| | - Vincenzo Salpietro
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, Università Di Milano, Milan, Italy
| | - Maurizio Delvecchio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
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3
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Stefanescu C, Boroi D, Iacob CI, Stefanescu V, Nechita A. Impact of the Patient-Doctor Relationship on Treatment Outcomes in Children with Type 1 Diabetes: A Meta-Analysis and Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1041. [PMID: 39334574 PMCID: PMC11430008 DOI: 10.3390/children11091041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/08/2024] [Accepted: 08/22/2024] [Indexed: 09/30/2024]
Abstract
(1) Background: Despite the recognized importance of the patient-doctor relationship (PDR) for pediatric diabetes management, the literature presents diverse and emerging findings regarding its impact on treatment outcomes for children with type 1 diabetes (T1D). (2) Methods: Using a meta-analytic approach, a comprehensive search for relevant studies was conducted across major databases, from the earliest study to June 2024. Inclusion criteria were studies on PDR and T1D outcomes in underaged individuals, providing quantitative results. (3) Results: Fifteen reports were included, showing a small but significant overall effect size (r = 0.165, p < 0.05) of PDR on T1D outcomes. Moderator analyses revealed significant associations from elements of PDR, duration of diagnosis, outcome assessment methods, information reporters, and being Caucasian. Demographic variables like gender, age, not being Caucasian, and caregiver's marital status did not significantly impact the association. Specific elements of PDR, such as clinician's objectives, communication, partnership, respect, and supportive care, showed significant positive effect sizes, while telecommunication did not. (4) Conclusions: A strong PDR is essential for managing diabetes in children, particularly in the early years of diagnosis. Future studies should use quantitative designs and include diverse demographics to better understand PDR's connection to T1D outcomes.
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Affiliation(s)
- Cristina Stefanescu
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800010 Galați, Romania; (C.S.); (V.S.); (A.N.)
| | - Denisa Boroi
- Faculty of Psychology and Educational Sciences, University of Bucharest, 050663 Bucharest, Romania;
| | - Claudia Iuliana Iacob
- Laboratory of Health Psychology and Clinical Neuropsychology, Department of Applied Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, University of Bucharest, 050663 Bucharest, Romania
| | - Victorița Stefanescu
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800010 Galați, Romania; (C.S.); (V.S.); (A.N.)
| | - Aurel Nechita
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800010 Galați, Romania; (C.S.); (V.S.); (A.N.)
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Olid-Cárdenas MJ, Lendínez-Jurado A, Monroy-Rodríguez G, Gómez-Perea A, Cano-Ortiz A, Ariza-Jiménez AB, García-Ruiz A, Jiménez-Cuenca P, Picón-César MJ, Leiva-Gea I. Real-World Use of Hybrid Closed-Loop Systems during Diabetes Camp: A Preliminary Study for Secure Configuration Strategies in Children and Adolescents. Nutrients 2024; 16:2210. [PMID: 39064653 PMCID: PMC11279836 DOI: 10.3390/nu16142210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
The introduction of closed-loop systems in the pediatric population has been a revolution in the management and evolution of diabetes. However, there are not many published studies in situations in which the feeding, schedules, and activities of the children deviate from the routine for which the systems were programmed, as in the case of a summer camp for children and adolescents with diabetes, where the specific programming of this device is not well known. It was a single-center prospective preliminary study. A total of twenty-seven patients (mean age 11.9 ± 1.9 years, 40% male, duration of diabetes 6.44 ± 2.83 years) were included (twenty with Medtronic MiniMed 780G system and seven with Tandem Control-IQ). Glucometric variables and pump functionality were monitored during the 7-day camp and in the following 3 weeks. There was no decrease from the objective TIR 70% at any moment. The worst results in Time Below Range were at 72 h from starting the camp, and the worst results in Time Above Range were in the first 24 h, with a progressive improvement after that. No episodes of level 3 hypoglycemia or ketoacidosis occurred. The use of specific programming in two integrated systems, with complex blood glucose regulation algorithms and not-prepared-for situations with increased levels of physical activity or abrupt changes in feeding routines, did not result in an increased risk of level 3 hypoglycemia and ketoacidosis for our pediatric type 1 diabetes (T1D) patients, regardless of the closed-loop device.
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Affiliation(s)
- María José Olid-Cárdenas
- Department of Marketing and Communication, Faculty of Communication, European University of Madrid, 28670 Villaviciosa de Odón, Spain;
- Faculty of Tourism, University of Malaga, Campus de Teatinos s/n, 29071 Málaga, Spain
- Andalucía Tech, Universidad de Málaga, Campus de Teatinos s/n, 29071 Málaga, Spain;
| | - Alfonso Lendínez-Jurado
- Andalucía Tech, Universidad de Málaga, Campus de Teatinos s/n, 29071 Málaga, Spain;
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (A.G.-P.); (P.J.-C.)
- Distrito Sanitario Málaga-Guadalhorce, 29009 Málaga, Spain;
| | - Gabriela Monroy-Rodríguez
- Department of Endocrinology and Nutrition, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Instituto de Investigación Sant Joan de Déu, 08950 Barcelona, Spain
| | - Ana Gómez-Perea
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (A.G.-P.); (P.J.-C.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
| | - Ana Cano-Ortiz
- Department of Didactics of Experimental, Social and Mathematical Sciences, Faculty of Education, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Ana B. Ariza-Jiménez
- Department of Pediatric Endocrinology, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain;
- Faculty of Medicine, University of Córdoba, Av. Menéndez Pidal, 7, 14004 Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | | | - Patricia Jiménez-Cuenca
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (A.G.-P.); (P.J.-C.)
| | - María José Picón-César
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Isabel Leiva-Gea
- Andalucía Tech, Universidad de Málaga, Campus de Teatinos s/n, 29071 Málaga, Spain;
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (A.G.-P.); (P.J.-C.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
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Savastio S, Gorla C, Pozzi E, Castorani V, Di Tonno R, Scaramuzza AE, Colasanto A, Coïsson JD, Arlorio M, Ferrante D, Bonfanti R, Rabbone I. Extended Bolus Is No More Needed for Risotto Meal in Children With Type 1 Diabetes Using Automated Insulin Delivery System: A Cohort Study. J Diabetes Sci Technol 2024; 18:991-992. [PMID: 38600836 PMCID: PMC11307224 DOI: 10.1177/19322968241246205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Silvia Savastio
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Carlotta Gorla
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Erica Pozzi
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Valeria Castorani
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
- Pediatric Diabetes Unit, San Raffaele Scientific Hospital and Vita Salute San Raffaele University, Milan, Italy
| | - Raffaella Di Tonno
- Pediatric Diabetes Unit, San Raffaele Scientific Hospital and Vita Salute San Raffaele University, Milan, Italy
| | - Andrea E. Scaramuzza
- ASST Cremona, Division of Pediatrics, Pediatric Diabetes, Endocrinology and Nutrition, Cremona, Italy
| | - Antonio Colasanto
- Department of Drug Science, University of Piemonte Orientale, Novara, Italy
| | | | - Marco Arlorio
- Department of Drug Science, University of Piemonte Orientale, Novara, Italy
| | - Daniela Ferrante
- Statistical Department, University of Piemonte Orientale, Novara, Italy
| | - Riccardo Bonfanti
- Pediatric Diabetes Unit, San Raffaele Scientific Hospital and Vita Salute San Raffaele University, Milan, Italy
| | - Ivana Rabbone
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
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6
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Maguolo A, Mazzuca G, Smart CE, Maffeis C. Postprandial glucose metabolism in children and adolescents with type 1 diabetes mellitus: potential targets for improvement. Eur J Clin Nutr 2024; 78:79-86. [PMID: 37875611 DOI: 10.1038/s41430-023-01359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023]
Abstract
The main goal of therapeutic management of type 1 Diabetes Mellitus (T1DM) is to maintain optimal glycemic control to prevent acute and long-term diabetes complications and to enable a good quality of life. Postprandial glycemia makes a substantial contribution to overall glycemic control and variability in diabetes and, despite technological advancements in insulin treatments, optimal postprandial glycemia is difficult to achieve. Several factors influence postprandial blood glucose levels in children and adolescents with T1DM, including nutritional habits and adjustment of insulin doses according to meal composition. Additionally, hormone secretion, enteroendocrine axis dysfunction, altered gastrointestinal digestion and absorption, and physical activity play important roles. Meal-time routines, intake of appropriate ratios of macronutrients, and correct adjustment of the insulin dose for the meal composition have positive impacts on postprandial glycemic variability and long-term cardiometabolic health of the individual with T1DM. Further knowledge in the field is necessary for management of all these factors to be part of routine pediatric diabetes education and clinical practice. Thus, the aim of this report is to review the main factors that influence postprandial blood glucose levels and metabolism, focusing on macronutrients and other nutritional and lifestyle factors, to suggest potential targets for improving postprandial glycemia in the management of children and adolescents with T1DM.
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Affiliation(s)
- Alice Maguolo
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy.
| | - Giorgia Mazzuca
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Carmel E Smart
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
- Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Claudio Maffeis
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
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7
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Scaramuzza AE, Marigliano M, Bonfanti R, Cherubini V, Schiaffini R, Toni S, Rabbone I. Implementing Control-IQ technology after a virtual educational camp in children and adolescents with type 1 diabetes: Does time in range plateau over 1 year? Diabetes Obes Metab 2024; 26:763-766. [PMID: 37871986 DOI: 10.1111/dom.15343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Andrea E Scaramuzza
- Pediatric Endocrinology and Diabetes, Pediatrics, ASST Cremona, Ospedale Maggiore, Cremona, Italy
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University Hospital, Verona, Italy
| | - Riccardo Bonfanti
- UO Pediatric Diabetes Research Institute, Ospedale San Raffaele, Milan, Italy
| | - Valentino Cherubini
- Pediatric Endocrinology and Diabetology Unit, Department of Women's and Children's Health, AOU Ospedali Riuniti di Ancona, "G. Salesi" Hospital, Ancona, Italy
| | | | - Sonia Toni
- Pediatric Diabetology and Endocrinology Unit, Meyer Children's Hospital IRCCS, Firenze, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
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8
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Franceschi R, Tornese G. Sustaining telehealth in pediatric diabetology beyond COVID-19: How to set the tone. Digit Health 2024; 10:20552076241249272. [PMID: 39156051 PMCID: PMC11329951 DOI: 10.1177/20552076241249272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/08/2024] [Indexed: 08/20/2024] Open
Abstract
In the post-COVID-19 era, telehealth experience and knowledge must be structured to deliver high-quality care. Type 1 diabetes is a chronic disease that lends itself to being a model for telehealth diffusion, especially in the pediatric setting where the use of cloud-connected technologies is widespread. Here, we present "how to set the tone" and manage a telemedicine session according to our experiences and those reported in the literature, according to the health professional perspective. A practical workflow on how healthcare professionals can structure a virtual diabetes clinic is reported, as well as critical issues related to limits in physical examination, communication registers, relationships, and visit settings. A proactive virtual visit model could be feasible, stratifying patients according to continuous glucose monitoring metrics, and personalized interventions can be provided to each patient. Analysis of benefits and hassles due to telehealth for each patient has to be considered, as well as their personal perspective, expectations, and reported barriers, mainly related to connection issues and digital literacy.
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Affiliation(s)
| | - Gianluca Tornese
- Pediatric Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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9
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Rossi A, Montefusco L, Reseghetti E, Pastore IF, Rossi G, Usuelli V, Loretelli C, Boci D, Ben Nasr M, D'Addio F, Bucciarelli L, Argenti S, Morpurgo P, Lunati ME, Fiorina P. Daytime hypoglycemic episodes during the use of an advanced hybrid closed loop system. Diabetes Res Clin Pract 2023; 206:111011. [PMID: 37956944 DOI: 10.1016/j.diabres.2023.111011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
AIMS The use of advanced hybrid closed loop systems is spreading due to the beneficial effects on glycometabolic control obtained in patients with type 1 diabetes. However, hypoglycemic episodes can be sometimes a matter of concern. We aim to compare the hypoglycemic risk of an advanced hybrid closed loop system and a predictive low glucose suspend sensor augmented pump. METHODS In this retrospective three months observational study, we included 30 patients using Medtronic Minimed™ 780G advanced hybrid closed loop system and 30 patients using a Medtronic Minimed™ predictive low glucose suspend sensor augmented pump. RESULTS The advanced hybrid closed loop system reduced the time spent above 180 mg/dL threshold and increased the time in range as compared to the predictive low glucose suspend. No severe hypoglycemia occurred in both groups and no differences were observed in the percentage of time spent below 70 mg/dl and 54 mg/dl glucose threshold. Nevertheless, more hypoglycemic episodes were recorded during daytime, but not in nighttime, with the use of the advanced hybrid closed loop system. CONCLUSIONS Our results confirmed the general improvement of glycemic outcomes obtained with the advanced hybrid closed loop system; however more hypoglycemic episodes during daytime were evident.
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Affiliation(s)
- Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Laura Montefusco
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elia Reseghetti
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | | | - Giada Rossi
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Vera Usuelli
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Cristian Loretelli
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; International Center for T1D - Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Milan, Italy
| | - Denisa Boci
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Moufida Ben Nasr
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; International Center for T1D - Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Milan, Italy
| | - Francesca D'Addio
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy; Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; International Center for T1D - Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Milan, Italy
| | | | - Sabrina Argenti
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Paola Morpurgo
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Paolo Fiorina
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy; Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; International Center for T1D - Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Milan, Italy; Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
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10
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Tindall LN, Xavier NA. Innovations in Diabetes Device Training: A Scoping Review. Endocr Pract 2023; 29:803-810. [PMID: 37290557 PMCID: PMC10245230 DOI: 10.1016/j.eprac.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The coronavirus disease 2019 pandemic highlighted a pre-existing need for alternatives to traditional in-person diabetes device trainings. Barriers to care, which include the heavy burden of training, pose a threat to optimal adoption and utilization of these devices. We searched the literature for alternative methods of training, evaluated user satisfaction, and compared short-term clinical outcomes with guideline-based glucometric targets and historical training results. METHODS A scoping review of Embase articles from 2019 to 2021 was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines using key words relevant to diabetes technologies. Original full-text articles investigating training of new users on devices were included. Titles and abstracts were screened for eligibility by 2 independent reviewers, and results were summarized. RESULTS Of 25 articles retrieved from the database, 11 met the criteria. Alternative training strategies included video conferencing, phone calls, mobile applications, and hybrids with traditional trainings. Overall, there was a high degree of user satisfaction with virtual visits, with a preference for hybrid approaches (6 articles). Although glucometrics varied between articles, short-term glucometrics were satisfactory overall (8 articles), including improved glycated hemoglobin measurements and time in range. Two articles compared time in range over various time points after traditional and remote training. One found equivalency, and the other identified a 5% improvement with remote training. CONCLUSION Alternative training approaches are a viable option to reduce the barriers to care and to alleviate training burden. Intentional implementation of alternatives should be considered a solution to address current barriers.
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Affiliation(s)
- Lacie N Tindall
- Department of Connected Care, Eli Lilly and Company, Indianapolis, Indiana
| | - Neena A Xavier
- Department of Connected Care, Eli Lilly and Company, Indianapolis, Indiana.
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11
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Castañeda J, Arrieta A, van den Heuvel T, Cohen O. The significance of coefficient of variation as a measure of hypoglycaemia risk and glycaemic control in real world users of the automated insulin delivery MiniMed 780G system. Diabetes Obes Metab 2023. [PMID: 37246797 DOI: 10.1111/dom.15139] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/30/2023]
Abstract
AIM Use of the MiniMed 780G system (MM780G) can result in a reduction in mean and standard deviation (SD) of sensor glucose (SG) values. We assessed the significance of the coefficient of variation (CV) as a measure of hypoglycaemia risk and glycaemic control. MATERIALS AND METHODS Data from 10 404 MM780G users were analysed using multivariable logistic regression to assess the contribution of CV to (a) hypoglycaemia risk, measured as not reaching target <1% for time below range (TBR), and (b) achieving targets of time-in-range (TIR) >70% and glucose management indicator <7%. CV was compared with SD and low blood glucose index. To assess the relevance of CV <36% as a therapeutic threshold, we identified the CV cut-off point that optimally discriminated users at risk of hypoglycaemia. RESULTS The contribution of CV was the smallest in terms of risk of hypoglycaemia (vs. low blood glucose index and SD) and TIR and glucose management indicator targets (vs. SD). In all cases the models with SD showed the best fit. A CV <43.4% (95% CI: 42.9-43.9) was the optimal cut-off point with a correct classification rate of 87.2% (vs. 72.9% for CV <36%). CONCLUSION For MM780G users, CV is a poor marker for hypoglycaemia risk and glycaemic control. We recommend using, for the former, TBR and whether the TBR target is met (and not using CV <36% as a therapeutic threshold for hypoglycaemia); for the latter, TIR, time above range, whether targets are met and a discrete description of mean SG and SD of SG values.
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Affiliation(s)
| | - Arcelia Arrieta
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | | | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
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Šumnik Z, Pavlíková M, Neuman V, Petruželková L, Konečná P, Venháčová P, Škvor J, Pomahačová R, Neumann D, Vosáhlo J, Strnadel J, Kocourková K, Obermannová B, Šantová A, Plachý L, Průhová S, Cinek O. Glycemic Control by Treatment Modalities: National Registry-Based Population Data in Children and Adolescents with Type 1 Diabetes. Horm Res Paediatr 2023; 97:70-79. [PMID: 37100041 DOI: 10.1159/000530833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION The aim of the study was to assess the differences in key parameters of type 1 diabetes (T1D) control associated with treatment and monitoring modalities including newly introduced hybrid closed-loop (HCL) algorithm in children and adolescents with T1D (CwD) using the data from the population-wide pediatric diabetes registry ČENDA. METHODS CwD younger than 19 years with T1D duration >1 year were included and divided according to the treatment modality and type of CGM used: multiple daily injection (MDI), insulin pump without (CSII) and with HCL function, intermittently scanned continuous glucose monitoring (isCGM), real-time CGM (rtCGM), and intermittent or no CGM (noCGM). HbA1c, times in glycemic ranges, and glucose risk index (GRI) were compared between the groups. RESULTS Data of a total of 3,251 children (mean age 13.4 ± 3.8 years) were analyzed. 2,187 (67.3%) were treated with MDI, 1,064 (32.7%) with insulin pump, 585/1,064 (55%) with HCL. The HCL users achieved the highest median TIR 75.4% (IQR 6.3) and lowest GRI 29.1 (7.8), both p < 0.001 compared to other groups, followed by MDI rtCGM and CSII groups with TIR 68.8% (IQR 9.0) and 69.0% (7.5), GRI 38.8 (12.5) and 40.1 (8.5), respectively (nonsignificant to each other). These three groups did not significantly differ in their HbA1c medians (51.8 [IQR 4.5], 50.7 [4.5], and 52.7 [5.7] mmol/mol, respectively). NoCGM groups had the highest HbA1c and GRI and lowest TIR regardless of the treatment modality. CONCLUSION This population-based study shows that the HCL technology is superior to other treatment modalities in CGM-derived parameters and should be considered as a treatment of choice in all CwD fulfilling the indication criteria.
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Affiliation(s)
- Zdenek Šumnik
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Marketa Pavlíková
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czechia
| | - Vit Neuman
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Lenka Petruželková
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Petra Konečná
- Department of Pediatrics, University Hospital Brno, Brno, Czechia
| | - Petra Venháčová
- Department of Pediatrics, University Hospital Olomouc, Olomouc, Czechia
| | - Jaroslav Škvor
- Department of Pediatrics, Masaryk Hospital, Ústí nad Labem, Czechia
| | - Renata Pomahačová
- Department of Pediatrics, University Hospital Pilsen, Pilsen, Czechia
| | - David Neumann
- Department of Pediatrics, University Hospital Hradec Králové, Hradec Králové, Czechia
| | - Jan Vosáhlo
- Department of Pediatrics, 3rd Faculty of Medicine, Prague, Czechia
| | - Jiri Strnadel
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czechia
| | - Kamila Kocourková
- Department of Pediatrics, Hospital České Budějovice, České Budějovice, Czechia
| | - Barbora Obermannová
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Alzbeta Šantová
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
- 1st Faculty of Medicine, Prague, Czechia
| | - Lukas Plachý
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Stepanka Průhová
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Ondrej Cinek
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
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Colasanto A, Savastio S, Pozzi E, Gorla C, Coïsson JD, Arlorio M, Rabbone I. The Impact of Different Types of Rice and Cooking on Postprandial Glycemic Trends in Children with Type 1 Diabetes with or without Celiac Disease. Nutrients 2023; 15:nu15071654. [PMID: 37049494 PMCID: PMC10096979 DOI: 10.3390/nu15071654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
The aims of this study were to evaluate: (i) the chemical and nutritional composition of rice before and after cooking and (ii) postprandial glycemic impacts in children and adolescents with type 1 diabetes (T1D) after eating two different types of rice (“Gigante Vercelli” white rice and “Artemide” black rice) or white rice cooked “risotto” style or boiled using an advanced hybrid closed loop (AHCL) system (Tandem Control-IQTM). General composition and spectrophotometric analyses of raw and cooked rice were performed. Eight T1D subjects (four males and four females, aged 11 ± 1.4 years), two with celiac disease (CD), using an AHCL system were enrolled. “Gigante Vercelli” white rice cooked as risotto or boiled and boiled “Artemide” rice were prepared by the same cook on two evenings. Continuous glucose monitoring metrics were evaluated for 12 h after meal consumption. Total dietary fiber was higher for both rice types after cooking compared with raw rice. Cooking as risotto increased polyphenols and antioxidants (p < 0.05) in both rice varieties, and total starch decreased after boiling (p < 0.05) in white rice. There was a significant peak in glycemia after consuming risotto and boiled white rice (p < 0.05), while the mean glycemic peak remained <180 mg/dL in individuals eating boiled Artemide rice. There were no significant differences in automatic basal or auto-bolus insulin deliveries by the AHCL according to different types of rice or cooking method. Our findings suggest that glycemic trends are impacted by the different chemical and nutritional profiles of rice but are nevertheless well controlled by AHCL systems.
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Bassi M, Patti L, Silvestrini I, Strati MF, Ponzano M, Minuto N, Maggi D. One-year follow-up comparison of two hybrid closed-loop systems in Italian children and adults with type 1 diabetes. Front Endocrinol (Lausanne) 2023; 14:1099024. [PMID: 36777356 PMCID: PMC9909036 DOI: 10.3389/fendo.2023.1099024] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND AIMS Tandem Control-IQ and MiniMed 780G are the main Advanced Hybrid Closed Loop (AHCL) systems currently available in pediatric and adult patients with Type 1 Diabetes (T1D). The aim of our study was to evaluate glycemic control after 1-year of follow-up extending our previous study of 1-month comparison between the two systems. METHODS We retrospectively compared clinical and continuous glucose monitoring (CGM) data from the patients included in the previous study which have completed 1-year observation period. The study population consisted of 74 patients, 42 Minimed 780G users and 32 Tandem Control-IQ users. Linear mixed models with random intercept were performed to study the variations over time and the interaction between time and system; Mann-Whitney or T-test were used to compare systems at 1-year. RESULTS Both systems have been shown to be effective in maintaining the glycemic improvement achieved one month after starting AHCL. Significant changes over time were observed for TIR, TAR, TAR>250mg/dl, average glucose levels and SD (p<0.001). At 1-year follow-up Minimed 780G obtained better improvement in TIR (p<0.001), TAR (p=0.002), TAR>250mg/dl (p=0.001), average glucose levels (p<0.001). The comparison of the glycemic parameters at 1-year showed a significant superiority of Minimed 780G in terms of TIR (71% vs 68%; p=0.001), TAR (p=0.001), TAR>250 (p=0.009), average glucose levels(p=0.001) and SD (p=0.031). CONCLUSIONS The use of AHCL systems led to a significant improvement of glycemic control at 1-month, which is maintained at 1-year follow-up. MiniMed is more effective than Tandem in reaching the International recommended glycemic targets. Continuous training and education in the use of technology is essential to get the best out of the most advanced technological tools.
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Affiliation(s)
- Marta Bassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Luca Patti
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Irene Silvestrini
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Marina Francesca Strati
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Marta Ponzano
- Department of Health Science (DiSSAL), University of Genoa, Genoa, Italy
| | - Nicola Minuto
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
- *Correspondence: Nicola Minuto,
| | - Davide Maggi
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
- Diabetes Clinic, IRCCS Ospedale Policlinico San Martino Genoa, Genoa, Italy
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15
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Machine Learning Approach for Care Improvement of Children and Youth with Type 1 Diabetes Treated with Hybrid Closed-Loop System. ELECTRONICS 2022. [DOI: 10.3390/electronics11142227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Type 1 diabetes is a disease affecting beta cells of the pancreas and it’s responsible for a decreased insulin secretion, leading to an increased blood glucose level. The traditional method for glucose treatment is based on finger-stick measurement of the blood glucose concentration and consequent manual insulin injection. Nowadays insulin pumps and continuous glucose monitoring systems are replacing them, being simpler and automatized. This paper focuses on analyzing and improving the knowledge about which Machine Learning algorithms can work best with glycaemic data and tries to find out the relation between insulin pump settings and glycaemic control. The dataset is composed of 90 days of recordings taken from 16 children and adolescents. Three Machine Learning approaches, two for classification, Logistic Regression (LR) and Random Forest (RL), and one for regression, Multivariate Linear Regression (MLR), have been used for the purpose. Specifically, the pump settings analysis was performed based on the Time In Range (TIR) computation and comparison consequent to pump setting changes. RF and MLR have shown the best results, while, for the settings’ analysis, the data show a discrete correlation between changes and TIRs. This study provides an interesting closer look at the data recorded by the insulin pump and a suitable starting point for a thorough and complete analysis of them.
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Scaramuzza AE, Bonfanti R, Cherubini V, Marigliano M, Schiaffini R, Toni S, Rabbone I. Comment on "Real-World Use of a New Hybrid Closed Loop Improves Glycemic Control in Youth with Type 1 Diabetes" by Messer et al. Diabetes Technol Ther 2022; 24:455-457. [PMID: 35544070 DOI: 10.1089/dia.2022.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Andrea Enzo Scaramuzza
- Unit of Pediatric Diabetes, Endocrinology and Nutrition, Division of Pediatrics, ASST Cremona, Italy
| | - Riccardo Bonfanti
- Department of Pediatrics, Diabetes Research Institute, San Raffaele Institute, Milano, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Italy
| | | | - Sonia Toni
- Pediatric Diabetology and Endocrinology Unit, Meyer Children's Hospital, Firenze, Italy
| | - Ivana Rabbone
- Department of Health and Science, University of Piemonte Orientale, Novara, Italy
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17
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Rabbone I, Savastio S, Pigniatiello C, Carducci C, Berioli MG, Cherubini V, Lo Presti D, Maltoni G, Mameli C, Marigliano M, Minuto N, Mozzillo E, Piccinno E, Predieri B, Rigamonti A, Ripoli C, Schiaffini R, Lombardo F, Tinti D, Toni S, Zanfardino A, Scaramuzza AE. Significant and persistent improvements in time in range and positive emotions in children and adolescents with type 1 diabetes using a closed-loop control system after attending a virtual educational camp. Acta Diabetol 2022; 59:837-842. [PMID: 35312860 PMCID: PMC8935105 DOI: 10.1007/s00592-022-01878-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the six-month impact of the advanced automated functions of a closed-loop control (CLC) system (Control-IQ) and a virtual educational camp (vEC) on emotions and time in range (TIR) of children and adolescents with type 1 diabetes. METHODS Children and their parents participated in a three-day vEC. Clinical, glucose, and emotion data were evaluated before, just after, and six months after the vEC. Emotions were evaluated using adapted Plutchik's and Geneva Emotion Wheels. RESULTS Forty-three children and adolescents (7-16 years) showed significant improvements in positive emotions immediately and six months after the vEC (67% and 65% vs 38%, p < 0.05, respectively), while mixed emotions were reduced (32% and 15% vs 61%, p < 0.05 and p < 0.001, respectively). The median percentage TIR increased from 64% (IQR 54-72) to 75% (IQR 70-82) with Control-IQ (p < 0.001) six months after the vEC. CONCLUSIONS Positive emotions (joy, serenity, and satisfaction) significantly improved while mixed emotions were significantly worse six months after the initiation of a CLC system (Control-IQ) and a vEC.
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Affiliation(s)
- Ivana Rabbone
- Department of Health and Science, University of Piemonte Orientale, Novara, Italy
| | - Silvia Savastio
- Department of Health and Science, University of Piemonte Orientale, Novara, Italy
| | - Ciro Pigniatiello
- Department of Health and Science, University of Piemonte Orientale, Novara, Italy
| | | | | | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | | | - Giulio Maltoni
- Pediatric Unit, IRCCS, Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Chiara Mameli
- Department of Pediatrics, Buzzi Children's Hospital, Università Di Milano, Milan, Italy
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | | | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, University of Naples Federico II, Napoli, Italy
| | - Elvira Piccinno
- Metabolic Diseases and Diabetology, Children's Hospital Giovanni XXIII, Bari, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Mdena and Reggio Emilia, Modena, Italy
| | - Andrea Rigamonti
- Department of Pediatrics, Diabetes Research Institute, San Raffaele Institute, Milano, Italy
| | - Carlo Ripoli
- Department of Pediatrics and Microcythemia, ARNAS G. Brotzu, Cagliari, Italy
| | | | - Fortunato Lombardo
- Department of Human Pathology in adult and developmental age, University of Messina, Messina, Italy
| | - Davide Tinti
- Department of Pediatrics, University of Torino, Torino, Italy
| | - Sonia Toni
- Pediatric Diabetology and Endocrinology Unit, Meyer Children's Hospital, Firenze, Italy
| | - Angela Zanfardino
- Regional Center of Pediatric Diabetology, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Andrea Enzo Scaramuzza
- Pediatric Diabetes, Endocrinology and Nutrition, Division of Pediatrics, ASST Cremona, Cremona, Italy.
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Messer LH. Reply to Scaramuzza et al.: Comment on "Real-World Use of a New Hybrid Closed Loop Improves Glycemic Control in Youth with Type 1 Diabetes" by Messer et al. Diabetes Technol Ther 2022; 24:458-459. [PMID: 35483068 DOI: 10.1089/dia.2022.0137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Laurel H Messer
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, Colorado, USA
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Di Molfetta S, Rossi A, Assaloni R, Cherubini V, Consoli A, Di Bartolo P, Guardasole V, Laurenzi A, Lombardo F, Maffeis C, Scaramuzza A, Irace C. A guide for the use of LibreView digital diabetes platform in clinical practice: Expert paper of the Italian Working Group on Diabetes and Technology. Diabetes Res Clin Pract 2022; 187:109867. [PMID: 35405166 DOI: 10.1016/j.diabres.2022.109867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022]
Abstract
Wider access to continuous glucose monitoring systems, including flash glucose monitoring, has enabled people with diabetes to achieve lower HbA1c levels and reduce the amount of time they spend in hypoglycaemia or hyperglycaemia, and has improved their quality of life. An International Consensus Panel proposed different target glucose ranges and recommendations according to different ages and situations (adults, young people and children with type 1 or type 2 diabetes, as well as elderly people who are at higher risk of hypoglycaemia, and women with diabetes during pregnancy). In this expert opinion, we interpret the international recommendations in the context of established clinical practice for diabetes care, and propose three different step-by-step algorithms to help the healthcare professionals use the most innovative glucose metrics, including time in glucose ranges, glucose management indicator, coefficient of variation, and ambulatory glucose profile. In detail, we focus on glucose metrics as measured by the FreeStyle Libre system and as visualized on the LibreView digital diabetes platform to support appropriate interpretation of flash glucose monitoring data. This is specifically structured for healthcare professionals and general practitioners who may have a low level of confidence with diabetes technology, with the aim of optimizing diabetes management, ensuring effective use of healthcare resources and to maximise outcomes for people with diabetes.
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Affiliation(s)
- Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Roberta Assaloni
- Diabetes Unit ASS2 Bassa-Friulana Isontina, Udine, Monfalcone, GO, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | - Agostino Consoli
- Endocrinology and Metabolic Diseases, University of Chieti-Pescara, Chieti, Italy
| | | | - Vincenzo Guardasole
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Andrea Laurenzi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, Verona, Italy
| | - Andrea Scaramuzza
- Division of Pediatrics, ASST Cremona, "Ospedale Maggiore di Cremona", Cremona, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
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Renard E, Tubiana-Rufi N, Bonnemaison E, Coutant R, Dalla-Vale F, Bismuth E, Faure N, Bouhours-Nouet N, Farret A, Storey C, Donzeau A, Poidvin A, Amsellem-Jager J, Place J, Breton MD. Outcomes of hybrid closed-loop insulin delivery activated 24/7 versus evening and night in free-living prepubertal children with type 1 diabetes: A multicentre, randomized clinical trial. Diabetes Obes Metab 2022; 24:511-521. [PMID: 34816597 DOI: 10.1111/dom.14605] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/01/2021] [Accepted: 11/14/2021] [Indexed: 11/29/2022]
Abstract
AIM To assess the safety and efficacy of hybrid closed-loop (HCL) insulin delivery 24/7 versus only evening and night (E/N), and on extended 24/7 use, in free-living children with type 1 diabetes. MATERIALS AND METHODS Prepubertal children (n = 122; 49 females/73 males; age, 8.6 ± 1.6 years; diabetes duration, 5.2 ± 2.3 years; insulin pump use, 4.6 ± 2.5 years; HbA1c 7.7% ± 0.7%/61 ± 5 mmol/mol) from four centres were randomized for 24/7 versus E/N activation of the Tandem Control-IQ system for 18 weeks. Afterwards, all children used the activated system 24/7 for 18 more weeks. The primary outcome was the percentage of time spent in the 70-180 mg/dL glucose range (TIR). RESULTS HCL was active 94.1% and 51.1% of the time in the 24/7 and E/N modes, respectively. TIR from baseline increased more in the 24/7 versus the E/N mode (52.9% ± 9.5% to 67.3% ± 5.6% [+14.4%, 95% CI 12.4%-16.7%] vs. 55.1% ± 10.8% to 64.7% ± 7.0% [+9.6%, 95% CI 7.4%-11.6%]; P = .001). Mean percentage time below range was similarly reduced, from 4.2% and 4.6% to 2.7%, and the mean percentage time above range decreased more in the 24/7 mode (41.9% to 30.0% [-11.9%, 95% CI 9.7%-14.6%] vs. 39.8% to 32.6% [-7.2%, 95% CI 5.0%-9.9%]; P = .007). TIR increased through the whole range of baseline levels and always more with 24/7 use. The results were maintained during the extension phase in those initially on 24/7 use and improved in those with initial E/N use up to those with 24/7 use. Neither ketoacidosis nor severe hypoglycaemia occurred. CONCLUSIONS The current study shows the safety and efficacy of the Tandem Control-IQ system in free-living children with type 1 diabetes for both E/N and 24/7 use; 24/7 use shows better outcomes, sustained for up to 36 weeks with no safety issues.
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Affiliation(s)
- Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- INSERM Clinical Investigation Centre 1411, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Nadia Tubiana-Rufi
- Department of Pediatric Endocrinology and Diabetology, Robert Debré University Hospital, University of Paris, Paris, France
| | | | - Régis Coutant
- Department of Pediatric Endocrinology and Diabetology, Angers University Hospital, Angers, France
| | - Fabienne Dalla-Vale
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Elise Bismuth
- Department of Pediatric Endocrinology and Diabetology, Robert Debré University Hospital, University of Paris, Paris, France
| | - Nathalie Faure
- Department of Pediatrics, Tours University Hospital, Tours, France
| | - Natacha Bouhours-Nouet
- Department of Pediatric Endocrinology and Diabetology, Angers University Hospital, Angers, France
| | - Anne Farret
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Caroline Storey
- Department of Pediatric Endocrinology and Diabetology, Robert Debré University Hospital, University of Paris, Paris, France
| | - Aurélie Donzeau
- Department of Pediatric Endocrinology and Diabetology, Angers University Hospital, Angers, France
| | - Amélie Poidvin
- Department of Pediatric Endocrinology and Diabetology, Robert Debré University Hospital, University of Paris, Paris, France
| | - Jessica Amsellem-Jager
- Department of Pediatric Endocrinology and Diabetology, Angers University Hospital, Angers, France
| | - Jérôme Place
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Marc D Breton
- Department of Pediatrics, Montpellier University Hospital, Montpellier, France
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Bassi M, Strati MF, Andreottola V, Calevo MG, d’Annunzio G, Maghnie M, Minuto N. To sleep or not to sleep: An Italian Control-IQ-uestion. Front Endocrinol (Lausanne) 2022; 13:996453. [PMID: 36578959 PMCID: PMC9790911 DOI: 10.3389/fendo.2022.996453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Tandem Control-IQ is an advanced hybrid closed loop (AHCL) system with a Sleep Activity Mode to intensify glycemic control overnight. The aim of the study is to evaluate the effectiveness of using Sleep Mode or not among Tandem Control-IQ users. RESEARCH DESIGN AND METHODS We performed a retrospective Tandem Control-IQ data download for patients followed at IRCCS G. Gaslini Pediatric Diabetes Centre. We divided the patients into group 1 (Sleep Mode users) and group 2 (non-users) and compared their overall glycemic data, particularly during nighttime. RESULTS Group 1 (n = 49) does not show better nocturnal glycemic control as expected when compared with group 2 (n = 34). Group 2 shows a nighttime TIR% of 69.50 versus 66.25 (p = 0.20). Only the patients who do not use Sleep Mode and with sensor and automatic mode use ≥90% reached TIR >70% during nighttime, as well as lower nocturnal TAR% (18.80 versus 21.78, p = 0.05). CONCLUSIONS This is the first study that evaluates the real-life effectiveness of the use of Sleep Mode in young patients with T1D. Control-IQ Sleep Activity Mode may not be as effective in Italian patients as in American patients due to the different habits.
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Affiliation(s)
- Marta Bassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marina Francesca Strati
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Valentina Andreottola
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Mohamad Maghnie
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nicola Minuto
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- *Correspondence: Nicola Minuto,
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Bassi M, Teliti M, Lezzi M, Iosca A, Strati MF, Carmisciano L, d’Annunzio G, Minuto N, Maggi D. A Comparison of Two Hybrid Closed-Loop Systems in Italian Children and Adults With Type 1 Diabetes. Front Endocrinol (Lausanne) 2021; 12:802419. [PMID: 35116007 PMCID: PMC8805205 DOI: 10.3389/fendo.2021.802419] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/23/2021] [Indexed: 12/11/2022] Open
Abstract
Tandem Control-IQ and Minimed 780G represent the most Advanced Hybrid Closed Loop (AHCL) systems currently available in pediatric and adult subjects with Type 1 Diabetes (T1D). We retrospectively compared clinical and continuous glucose monitoring data from 51 patients who upgraded to Minimed 780G system and have completed 1-month observation period with data from 39 patients who upgraded to Tandem Control-IQ. Inverse probability weighting was used to minimize the basal characteristics imbalances. Both AHCL systems showed a significant improvement in glycemic parameters. Minimed 780G group achieved higher TIR increase (p= 0.004) and greater reduction of blood glucose average (p= 0.001). Tandem Control-IQ system significantly reduced the occurrence of TBR (p= 0.010) and the Coefficient of Variation of glucose levels (p= 0.005). The use of ACHL systems led to a significant improvement of glycemic control substantially reaching the International recommended glycemic targets. Minimed 780G appears to be more effective in managing hyperglycemia, while Tandem Control-IQ seems to be more effective in reducing time in hypoglycemia.
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Affiliation(s)
- Marta Bassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Marsida Teliti
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Marilea Lezzi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Arianna Iosca
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Marina Francesca Strati
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Luca Carmisciano
- Department of Helath Science (DiSSAL), University of Genoa, Genoa, Italy
| | - Giuseppe d’Annunzio
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Nicola Minuto
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
- *Correspondence: Nicola Minuto,
| | - Davide Maggi
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
- Department of Helath Science (DiSSAL), University of Genoa, Genoa, Italy
- Diabetes Clinic, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino Genoa, Genoa, Italy
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