1
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McFadden NT, Wilkerson AH, Jaiswal J, Chaney BH, Stellefson ML, Carmack HJ, Lovett K. Barriers and Facilitators Impacting Disease and Symptom Management Among College Students With Type 1 Diabetes: A Qualitative Study. Am J Health Promot 2024; 38:704-715. [PMID: 38342487 DOI: 10.1177/08901171241233407] [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] [Indexed: 02/13/2024]
Abstract
PURPOSE This study aimed to explore barriers and facilitators impacting disease and symptom management among college students living with Type 1 Diabetes (T1D). DESIGN A qualitative, phenomenological approach using semi-structured, one-on-one interviews. SETTING Interviews conducted on Zoom (n = 28) and in-person (n = 3). PARTICIPANTS Purposive sample of 31 college students living with T1D for at least 2 years who attended large, 4-year public universities in the Southeastern United States. METHOD This study was theoretically informed using the Middle-Range Theory of Self-Care of Chronic Illness Integration of Symptoms to develop interview questions. Interviews were transcribed verbatim and uploaded in NVivo. Data were analyzed thematically using a codebook developed by the research team using the theory as a framework. Trustworthiness was established using an audit trail, memos, and negative case analysis. RESULTS Four themes described barriers: diabetes burnout, challenges adjusting to a college lifestyle, difficulty receiving medical supplies, and insurance limitations. Five themes explained facilitators: years of experience managing T1D, tangible support with medical supplies, informational support for disease management, and emotional/technological support for disease and symptom management. CONCLUSION Barriers and facilitators in this study should be addressed in future T1D interventions for college students. Findings can also guide healthcare professionals, health promotion practitioners, family, friends, and significant others on how to better support college students as they manage T1D.
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Affiliation(s)
- Ny'Nika T McFadden
- Department of Health and Human Performance, Texas State University, San Marcos, TX, USA
| | - Amanda H Wilkerson
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Jessica Jaiswal
- Department of Family and Community Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Beth H Chaney
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | | | - Heather J Carmack
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kylie Lovett
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
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2
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Chen CW, Tinsley LJ, Volkening LK, Anderson BJ, Laffel LM. Observed Characteristics Associated with Diabetes Device Use Among Teens with Type 1 Diabetes. J Diabetes Sci Technol 2023; 17:186-194. [PMID: 34652236 PMCID: PMC9846387 DOI: 10.1177/19322968211050069] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite advancements in diabetes technologies, disparities remain with respect to diabetes device use in youth with type 1 diabetes (T1D). We compared sociodemographic, diabetes, and psychosocial characteristics associated with device (pump and continuous glucose monitor [CGM]) use in 13- to 17-year-old teens with T1D. MATERIALS/METHODS Data were derived from a multicenter clinical trial to optimize self-care and glycemic control in teens with T1D. We categorized teens as pump users versus non-users and CGM users versus non-users based on their diabetes device usage. Chi-square and t-tests compared characteristics according to device use. RESULTS The sample comprised 301 teens (50% female) with baseline mean ± SD age 15.0 ± 1.3 years, T1D duration 6.5 ± 3.7 years, and HbA1c 8.5 ± 1.1% (69 ± 12 mmol/mol). Two-thirds (65%) were pump users, and 27% were CGM users. Pump users and CGM users (vs. non-users) were more likely to have a family annual household income ≥$150,000, private health insurance, and a parent with a college education (all P < .001). Pump users and CGM users (vs. non-users) also performed more frequent daily blood glucose (BG) checks (both P < .001) and reported more diabetes self-care behaviors (both P < .05). Pump users were less likely to have baseline HbA1c ≥9% (75 mmol/mol) (P = .005) and to report fewer depressive symptoms (P = .02) than pump non-users. Parents of both CGM and pump users reported a higher quality of life in their youth (P < .05). CONCLUSION There were many sociodemographic, diabetes-specific, and psychosocial factors associated with device use. Modifiable factors can serve as the target for clinical interventions; youth with non-modifiable factors can receive extra support to overcome potential barriers to device use.
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Affiliation(s)
- Charlotte W. Chen
- Joslin Diabetes Center, Boston, MA,
USA
- Boston Children’s Hospital, Boston, MA,
USA
| | | | | | | | - Lori M. Laffel
- Joslin Diabetes Center, Boston, MA,
USA
- Boston Children’s Hospital, Boston, MA,
USA
- Lori M. Laffel, MD, MPH, Joslin Diabetes
Center, 1 Joslin Place, Boston, MA 02215, USA.
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3
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Pauley ME, Berget C, Messer LH, Forlenza GP. Barriers to Uptake of Insulin Technologies and Novel Solutions. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:339-354. [PMID: 34803408 PMCID: PMC8594891 DOI: 10.2147/mder.s312858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/29/2021] [Indexed: 12/15/2022] Open
Abstract
Diabetes-related technology has undergone great advancement in recent years. These technological devices are more commonly utilized in the type 1 diabetes population, which requires insulin as the primary treatment modality. Available devices include insulin pumps, continuous glucose monitors, and hybrid systems referred to as automated insulin delivery systems or hybrid closed-loop systems, which combine those two devices along with software algorithms to achieve advanced therapeutic capabilities, including automatic modulation of insulin delivery based on sensor-derived glucose levels to minimize abnormal glucose trends. Use of diabetes technology is associated with significant positive health and psychosocial outcomes, yet utilization rates are generally lacking across both adult and pediatric type 1 diabetes populations in the United States and other countries. There are consistent themes in existing barriers to technology uptake reported by individuals with type 1 diabetes or parents of children with type 1 diabetes, including physical burdens associated with wearing the devices, concerns in navigating the technology and the devices’ abilities to meet user expectations, high cost, inadequate resources within the healthcare team to support device use, disparities in technology access, and psychosocial barriers. It is important to understand the common barriers to uptake of not only the automated insulin delivery systems but also their component devices (insulin pumps and continuous glucose monitors) to fully support individuals in utilizing these devices and optimizing health benefits. The purpose of this article is to summarize the current automated insulin delivery devices that are available for use in management of type 1 diabetes, review common barriers to uptake of those systems and their component devices, and provide expert opinion on existing and future solutions to identified barriers.
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Affiliation(s)
- Meghan E Pauley
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cari Berget
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laurel H Messer
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gregory P Forlenza
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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4
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Brew-Sam N, Chhabra M, Parkinson A, Hannan K, Brown E, Pedley L, Brown K, Wright K, Pedley E, Nolan CJ, Phillips C, Suominen H, Tricoli A, Desborough J. Experiences of Young People and Their Caregivers of Using Technology to Manage Type 1 Diabetes Mellitus: Systematic Literature Review and Narrative Synthesis. JMIR Diabetes 2021; 6:e20973. [PMID: 33528374 PMCID: PMC7886614 DOI: 10.2196/20973] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/23/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In the last decade, diabetes management has begun to transition to technology-based care, with young people being the focus of many technological advances. Yet, detailed insights into the experiences of young people and their caregivers of using technology to manage type 1 diabetes mellitus are lacking. OBJECTIVE The objective of our study was to describe the breadth of experiences and perspectives on diabetes technology use among children and adolescents with type 1 diabetes mellitus and their caregivers. METHODS This systematic literature review used integrated thematic analysis to guide a narrative synthesis of the included studies. We analyzed the perspectives and experiences of young people with type 1 diabetes mellitus and their caregivers reported in qualitative studies, quantitative descriptive studies, and studies with a mixed methods design. RESULTS Seventeen articles met the inclusion criteria, and they included studies on insulin pump, glucose sensors, and remote monitoring systems. The following eight themes were derived from the analysis: (1) expectations of the technology prior to use, (2) perceived impact on sleep and overnight experiences, (3) experiences with alarms, (4) impact on independence and relationships, (5) perceived usage impact on blood glucose control, (6) device design and features, (7) financial cost, and (8) user satisfaction. While many advantages of using diabetes technology were reported, several challenges for its use were also reported, such as cost, the size and visibility of devices, and the intrusiveness of alarms, which drew attention to the fact that the user had type 1 diabetes mellitus. Continued use of diabetes technology was underpinned by its benefits outweighing its challenges, especially among younger people. CONCLUSIONS Diabetes technologies have improved the quality of life of many young people with type 1 diabetes mellitus and their caregivers. Future design needs to consider the impact of these technologies on relationships between young people and their caregivers, and the impact of device features and characteristics such as size, ease of use, and cost.
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Affiliation(s)
- Nicola Brew-Sam
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Madhur Chhabra
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Kristal Hannan
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Ellen Brown
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Lachlan Pedley
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Karen Brown
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Kristine Wright
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Elizabeth Pedley
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Christopher J Nolan
- Canberra Health Services, Canberra, Australia.,ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia.,The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Hanna Suominen
- School of Computing, College of Engineering and Computer Science, Australian National University, Canberra, Australia.,Department of Computing, University of Turku, Turku, Finland.,Data61, Commonwealth Scientific and Industrial Research Organisation, Canberra, Australia
| | - Antonio Tricoli
- The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australia.,Nanotechnology Research Lab, Research School of Chemistry, College of Science, Australian National University, Canberra, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
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5
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Pulungan AB, Fadiana G, Annisa D. Type 1 diabetes mellitus in children: experience in Indonesia. Clin Pediatr Endocrinol 2021; 30:11-18. [PMID: 33446947 PMCID: PMC7783121 DOI: 10.1297/cpe.30.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/18/2020] [Indexed: 01/11/2023] Open
Abstract
The prevalence of type 1 diabetes mellitus (T1DM) in children in Indonesia is increasing
although the real number is unknown due to high rate of misdiagnosis. Public and
healthcare awareness on T1DM in children is still low, reflected by the high number of
children diagnosed with diabetic ketoacidosis (DKA). The Indonesian Pediatric Society
(IPS) had published a guideline on T1DM management, which consists of insulin injection,
daily monitoring of blood glucose, nutrition, physical activity, and education. Aside from
low awareness, current challenges on T1DM management in Indonesia are funding by the
national health insurance, fasting during Ramadan, and inequities on DM care. The
involvement of society, healthcare workers, stakeholders, and the government is of
importance to ensure optimal management for children with diabetes.
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Affiliation(s)
- Aman B Pulungan
- Child Health Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Ghaisani Fadiana
- Child Health Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Diadra Annisa
- Child Health Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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6
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Messer LH, Tanenbaum ML, Cook PF, Wong JJ, Hanes SJ, Driscoll KA, Hood KK. Cost, Hassle, and On-Body Experience: Barriers to Diabetes Device Use in Adolescents and Potential Intervention Targets. Diabetes Technol Ther 2020; 22:760-767. [PMID: 32163719 DOI: 10.1089/dia.2019.0509] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Adolescents with diabetes have the highest A1cs of all age groups. Diabetes devices (insulin pumps and continuous glucose monitors [CGM]) can improve glycemic outcomes, and although the uptake of devices has increased, they remain underutilized in this population. This study characterizes adolescent-reported barriers to diabetes device use to determine targets for clinician intervention. Methods: We surveyed 411 adolescents with type 1 diabetes (mean age 16.30 ± 2.25 years) on barriers to diabetes device use, technology use attitudes (general and diabetes specific), benefits and burdens of CGM, self-efficacy for diabetes care, diabetes distress, family conflict, and depression. We characterize barriers to device uptake; assess demographic and psychosocial differences in device users, discontinuers, and nonusers; and determine differences in device use by gender and age. Results: The majority of adolescents used an insulin pump (n = 307, 75%) and more than half used CGM (n = 225, 55%). Cost/insurance-related concerns were the most commonly endorsed barrier category (61%) followed by wear-related issues (58.6%), which include the hassle of wearing the device (38%) and dislike of device on the body (33%). Adolescents who endorsed more barriers also reported more diabetes distress (P = 0.003), family conflict (P = 0.003), and depressive symptoms (P = 0.014). Pump and CGM discontinuers both endorsed more barriers and more negative perceptions of technology than current users, but reported no difference from device users in diabetes distress, family conflict, or depression. Gender was not related to the perceptions of devices. Conclusions: Clinicians can proactively assess attitudes toward diabetes technology and perceptions of benefits/burdens to encourage device uptake and potentially prevent device discontinuation among adolescents.
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Affiliation(s)
- Laurel H Messer
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, Colorado
| | - Molly L Tanenbaum
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Paul F Cook
- College of Nursing, University of Colorado, Aurora, Colorado
| | - Jessie J Wong
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Sarah J Hanes
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Kimberly A Driscoll
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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7
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Abstract
Regular self-monitoring of blood glucose levels, and ketones when indicated, is an essential component of type 1 diabetes (T1D) management. Although fingerstick blood glucose monitoring has been the standard of care for decades, ongoing rapid technological developments have resulted in increasingly widespread use of continuous glucose monitoring (CGM). This article reviews recommendations for self-monitoring of glucose and ketones in pediatric T1D with particular emphasis on CGM and factors that impact the accuracy and real-world use of this technology.
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Affiliation(s)
- Brynn E. Marks
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington, DC, United States
- *Correspondence: Brynn E. Marks
| | - Joseph I. Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States
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8
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Messer LH, Cook PF, Tanenbaum ML, Hanes S, Driscoll KA, Hood KK. CGM Benefits and Burdens: Two Brief Measures of Continuous Glucose Monitoring. J Diabetes Sci Technol 2019; 13:1135-1141. [PMID: 30854886 PMCID: PMC6835174 DOI: 10.1177/1932296819832909] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Continuous glucose monitors (CGM) are underutilized by individuals with type 1 diabetes (T1D), particularly during the adolescent years. Little is known about perceptions of CGM benefit and burdens, and few tools exist to quantify this information. METHODS Two questionnaires were developed and validated-Benefit of CGM (BenCGM) and Burdens of CGM (BurCGM)-in a sample of adolescents ages 12-19 years involved in the T1D Exchange Registry. We chose to start the validation process with adolescents given their low CGM uptake and high risk for suboptimal glycemic outcomes. Exploratory and confirmatory factor analyses were conducted to confirm factor structure and select items. The resultant scales were tested for internal reliability and convergent/divergent validity with critical diabetes and quality of life outcomes: age, depression, diabetes distress, self-efficacy, technology attitudes, and diabetes technology attitudes. RESULTS A total of 431 adolescents with T1D completed the questionnaires (51% female, mean age 16.3 ± 2.26, 83% white non-Hispanic, 70% having used CGM). Two single factor scales emerged, and scales were reduced to 8 items each. Those who perceived higher benefit of CGM exhibited lower diabetes distress, higher self-efficacy, and more positive attitudes toward technology. Those who perceived higher burden of CGM exhibited higher diabetes distress, lower self-efficacy, and less positive technology attitudes. CONCLUSION The BenCGM and BurCGM questionnaires each comprise 8-items that demonstrate robust psychometric properties for use in adolescents with T1D, and can be used to develop targeted interventions to increase CGM wear to improve diabetes management.
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Affiliation(s)
- Laurel H. Messer
- University of Colorado Anschutz, Barbara Davis Center for Childhood Diabetes, Aurora, CO, USA
- Laurel Messer, University of Colorado Anschutz, Barbara Davis Center for Diabetes, 1775 Aurora Court, MS A140 (bldg M20-2404) Aurora, CO 80045, USA.
| | - Paul F. Cook
- University of Colorado Anschutz, College of Nursing, Aurora, CO, USA
| | - Molly L. Tanenbaum
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah Hanes
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Kimberly A. Driscoll
- University of Colorado Anschutz, Barbara Davis Center for Childhood Diabetes, Aurora, CO, USA
| | - Korey K. Hood
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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9
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Smith MB, Albanese-O'Neill A, Macieira TGR, Yao Y, Abbatematteo JM, Lyon D, Wilkie DJ, Haller MJ, Keenan GM. Human Factors Associated with Continuous Glucose Monitor Use in Patients with Diabetes: A Systematic Review. Diabetes Technol Ther 2019; 21:589-601. [PMID: 31335196 DOI: 10.1089/dia.2019.0136] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Consistent continuous glucose monitor (CGM) use is associated with substantial improvements in glycemic control, yet the uptake and continued use of these technologies remains low. This systematic review aims to identify and summarize the state of science on human factors and their association with CGM use to inform training methods and best practices that support adherence to CGM use and automated insulin delivery systems. A literature search was conducted in PubMed, CINAHL, The Cochrane Library, and PsychInfo databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify studies that reported psychological human factors related to CGM or sensor-augmented pump use in patients with type 1 diabetes. In total, 389 records were identified through our database search and 26 studies published between 2010 and 2017 were included. Articles underwent quality appraisal using the Effective Public Health Practice Project Quality Assessment Tool and were categorized according to study outcomes. Identified human factors with a potential association with CGM use were treatment satisfaction, quality of life, emotional distress, and self-efficacy. Eight patient-reported barriers to CGM use were identified as a subcomponent of satisfaction. To date, studies of human factors associated with CGM use generally lack standardized measures and sufficient methodological rigor necessary to establish causation. A more robust understanding of how identified human factors influence CGM use is necessary. Future studies should test interventions that target human factors to improve consistency of use and establish best practices for enhancing patients' experience and acceptance of these technologies, especially within adolescents and young adults.
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Affiliation(s)
- Madison B Smith
- PhD Program, College of Nursing, University of Florida, Gainesville, Florida
| | | | - Tamara G R Macieira
- PhD Program, College of Nursing, University of Florida, Gainesville, Florida
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | | | - Debra Lyon
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Michael J Haller
- Division of Pediatric Endocrinology, College of Medicine, University of Florida, Gainesville, Florida
| | - Gail M Keenan
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida
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DiMeglio LA, Acerini CL, Codner E, Craig ME, Hofer SE, Pillay K, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:105-114. [PMID: 30058221 DOI: 10.1111/pedi.12737] [Citation(s) in RCA: 373] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 07/27/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology and Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ethel Codner
- Institute of Maternal and Child Research (IDMI), School of Medicine, Universidad de Chile, Santiago, Chile
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, Australia
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - David M Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
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11
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Forlenza GP, Messer LH, Berget C, Wadwa RP, Driscoll KA. Biopsychosocial Factors Associated With Satisfaction and Sustained Use of Artificial Pancreas Technology and Its Components: a Call to the Technology Field. Curr Diab Rep 2018; 18:114. [PMID: 30259309 PMCID: PMC6535227 DOI: 10.1007/s11892-018-1078-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Summarize biopsychosocial factors associated with using continuous glucose monitors (CGMs), insulin pumps, and artificial pancreas (AP) systems and provide a "call to the field" about their importance to technology uptake and maintained use. RECENT FINDINGS Insulin pumps and CGMs are becoming standard of care for individuals with type 1 diabetes (T1D). AP systems combining a CGM, insulin pump, and automated dosing algorithm are available for commercial use. Despite improved glycemic control with AP system use, numerous barriers exist which may limit their benefit. Studies on components of AP systems (pumps, CGMs) are limited and demonstrate mixed results of their impact on fear of hypoglycemia, adherence, quality of life, depression and anxiety, and diabetes distress. Studies examining biopsychological factors associated specifically with sustained use of AP systems are also sparse. Biological, psychological and social impacts of AP systems have been understudied and the information they provide has not been capitalized upon.
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Affiliation(s)
- Gregory P. Forlenza
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
| | - Laurel H. Messer
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
| | - Cari Berget
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
| | - R. Paul Wadwa
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
| | - Kimberly A. Driscoll
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
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12
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Messer LH, Johnson R, Driscoll KA, Jones J. Best friend or spy: a qualitative meta-synthesis on the impact of continuous glucose monitoring on life with Type 1 diabetes. Diabet Med 2018; 35:409-418. [PMID: 29247556 DOI: 10.1111/dme.13568] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 01/02/2023]
Abstract
AIMS This is a meta-synthesis of extant qualitative literature related to impact of continuous glucose monitoring (CGM). CGM has been available for a decade for the management of Type 1 diabetes and is the lynchpin of future artificial pancreas technologies. Clinical uptake of CGM is an important area of inquiry. The purpose of this meta-synthesis is to understand the impact of CGM on individuals with Type 1 diabetes and others (parents, significant others, providers) in order to design appropriate clinical interventions for adherence. METHODS Studies published in English between 2007 and 2017 were included, reflecting commercial CGM availability. PubMed, PsychINFO, CINALH, Web of Science and EMBASE databases were queried using search terms related to CGM, qualitative, experience and Type 1 diabetes. Included articles contained original qualitative or mixed-method research on CGM, sensor-augmented pump or closed-loop therapies. Articles underwent quality appraisal and thematic interpretive integration by a multidisciplinary team. RESULTS Nine articles (343 participants) met the inclusion criteria and were included in the synthesis. Six novel themes emerged: interacting with CGM, burden of living with CGM, feeling different from others, feeling empowered, interacting with glucose information and impact on relationships. CONCLUSION CGM affects physical, emotional and relational aspects of life. Clinicians can help minimize the burden of CGM with carefully delivered education and expectation-setting with individuals. Empowerment and relational partnerships in diabetes care can be explored to maximize satisfaction with CGM. Systematic interpretive synthesis of qualitative studies provides a comprehensive, contextual understanding of the impact of CGM on daily life and relationships.
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Affiliation(s)
- L H Messer
- University of Colorado, Barbara Davis Center, Aurora
- University of Colorado, College of Nursing, Denver, CO, USA
| | - R Johnson
- University of Colorado, College of Nursing, Denver, CO, USA
| | - K A Driscoll
- University of Colorado, Barbara Davis Center, Aurora
| | - J Jones
- University of Colorado, College of Nursing, Denver, CO, USA
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Laffel LM, Aleppo G, Buckingham BA, Forlenza GP, Rasbach LE, Tsalikian E, Weinzimer SA, Harris DR. A Practical Approach to Using Trend Arrows on the Dexcom G5 CGM System to Manage Children and Adolescents With Diabetes. J Endocr Soc 2017; 1:1461-1476. [PMID: 29344578 PMCID: PMC5760209 DOI: 10.1210/js.2017-00389] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/03/2017] [Indexed: 01/15/2023] Open
Abstract
After assessing previously published methods, we developed a practical approach to adjusting insulin doses using rtCGM trend arrows in pediatric patients with diabetes.
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Affiliation(s)
- Lori M Laffel
- Pediatric, Adolescent and Young Adult Programs, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611
| | - Bruce A Buckingham
- Department of Pediatric Endocrinology, Stanford University, Stanford, California 94305
| | - Gregory P Forlenza
- Barbara Davis Center, University of Colorado Denver, Aurora, Colorado 80045
| | - Lisa E Rasbach
- Division of Pediatric Endocrinology, Johns Hopkins Children's Center, Baltimore, Maryland 21287
| | - Eva Tsalikian
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242
| | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06510
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14
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Visekruna S, McGillis Hall L, Parry M, Spalding K. Intersecting Health Policy and the Social Determinants of Health in Pediatric Type 1 Diabetes Management and Care. J Pediatr Nurs 2017; 37:62-69. [PMID: 28683888 DOI: 10.1016/j.pedn.2017.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/08/2017] [Accepted: 06/03/2017] [Indexed: 12/20/2022]
Abstract
THEORETICAL PRINCIPLES Type 1 diabetes health technologies are evolving. This is an expensive chronic condition to manage, hence a combination of public and private healthcare funding sources, as well as out-of-pocket payments support disease management. The aim of this paper is to describe two conceptual underpinnings, which can appropriately position the health policy and clinical context of pediatric type 1 diabetes management and care. PHENOMENA ADDRESSED: "The Main Determinants of Health" framework is used to position pediatric T1D management and care within the model's four interconnected layers: the structural environment, social and material conditions, support systems and individual health behaviors. A health policy in Ontario, Canada, the Assistive Devices Program for insulin pump therapy is also discussed relative to the model's outermost layer: the structural environment. Four dimensions of control, which characterize the "street-level bureaucrat" role including "distributing benefits and sanctions; structuring the context; teaching the client role; and, psychological benefits and sanctions" then position the policy context of the diabetes nurse educator role relative to the Assistive Devices Program policy. RESEARCH LINKAGES These conceptual underpinnings could extend beyond the pediatric T1D landscape to position global research in other nursing practice areas, as well as with other patient populations and professional disciplines such as social work and medicine.
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Affiliation(s)
- Sanja Visekruna
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Linda McGillis Hall
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Karen Spalding
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, Ontario, Canada.
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15
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Hussain T, Akle M, Nagelkerke N, Deeb A. Comparative study on treatment satisfaction and health perception in children and adolescents with type 1 diabetes mellitus on multiple daily injection of insulin, insulin pump and sensor-augmented pump therapy. SAGE Open Med 2017; 5:2050312117694938. [PMID: 28321303 PMCID: PMC5347412 DOI: 10.1177/2050312117694938] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/25/2017] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Diabetes management imposes considerable demands on patients. Treatment method used has an impact on treatment satisfaction. We aim to examine the relationship between treatment satisfaction and health perception with the method used for treatment of type 1 diabetes mellitus in children and adolescents. SUBJECTS AND METHOD We have interviewed patients with type 1 diabetes mellitus using questionnaires to assess treatment satisfaction and health perception. Patients were divided into three groups based on treatment used: multiple daily injection, insulin pump and sensor-augmented pump therapy. Comparison of scores was done between the groups. RESULTS A total of 72 patients were enrolled (36 males). Mean age (standard deviation) was 11.4 (4.4) years and duration of diabetes of 4.9 (3.5) years. Mean (standard deviation) HbA1c was 8.1 (1.2). Median (range) duration of sensor use was 17.7 (3-30) days/month. Mean scale for treatment satisfaction and health perception questions was 25.3, 29.7 and 31.7 and 60, 79.7 and 81 for the multiple daily injection, pump and sensor-augmented pump, respectively (p = 0.00). Significant difference was seen between the multiple daily injection and both other groups. Sensor-augmented pump group scored higher than the pump group. However, the difference was not statistically significant. Duration of sensor use showed no correlation with treatment satisfaction. CONCLUSION The method used for diabetes treatment has an impact on patients' satisfaction and health perception in children and adolescents with type 1 diabetes mellitus. Insulin pump users have a higher treatment satisfaction and better health perception than those on multiple daily injection. Augmenting pump therapy with sensor use adds value to treatment satisfaction without correlation with the duration of the sensors use.
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Affiliation(s)
- Tara Hussain
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Mariette Akle
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Nico Nagelkerke
- Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
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16
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Abstract
Glucose monitoring is prerequisite to all other diabetes self-care behaviors and helps patients to reduce their risk for diabetes-related complications due to elevated glycemia. Because of the amount of information available and the ability to deliver glucose results in real-time, continuous glucose monitoring (CGM) has the ability to improve on self-monitoring blood glucose. However, epidemiologic data demonstrate slow uptake of CGM by patients, especially among youth. Several new diabetes therapies rely on CGM for feedback on patients' glucose levels to optimize treatment (eg, the low-glucose suspend insulin pump) and there are new technologies currently in development that will also need this information to work (eg, the artificial pancreas). To help patients to realize the potential benefits of these new treatments, it is essential to explore patients' psychological and behavioral reactions to CGM and then target device enhancements and/or the development of behavioral therapies to minimize negative reactions and to improve patients' CGM adoption rates. Limited research is available examining the psychological and behavioral reactions of CGM use in youth exclusively, but there are more studies examining these reactions in mixed samples of youth, parents, and adults. The purpose of this review is to summarize the available literature examining psychological and behavioral reactions to CGM use in young people with diabetes and to highlight how the results of past and future studies can inform device updates and/or behavioral intervention development to minimize barriers.
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Affiliation(s)
- Susana R Patton
- University of Kansas Medical Center, Kansas City, KS, USA Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO, USA
| | - Mark A Clements
- Children's Mercy-Kansas City, Kansas City, MO, USA University of Missouri-Kansas City, Kansas City, MO, USA
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17
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Abstract
Although anxiety is a normal and developmentally appropriate experience of childhood and anxiety disorders are among the most commonly diagnosed disorders, the prevalence of anxiety symptomatology and anxiety disorders in children with type 1 diabetes (T1D) is not well documented. Most studies have focused on anxiety-related syndromes associated with T1D including fear of hypoglycemia, specific phobia of needles (i.e., needle anxiety), and anxiety related to uptake of new and sophisticated diabetes technology (e.g., continuous glucose monitors, continuous subcutaneous infusion therapy), but the extant literature is sparse, and more research is greatly needed. Identification, prevention, and treatment of anxiety are critical to providing comprehensive diabetes care and management. This review provides a summary of the literature focused on anxiety in children and adolescents with T1D with suggestions for future research and clinical implications.
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Affiliation(s)
- Shideh Majidi
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, 1775 Aurora Ct, A140, Aurora, CO, 80045, USA,
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18
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Affiliation(s)
- Ling Hinshaw
- Endocrine Research Unit, Division of Endocrinology and Metabolism, Mayo Clinic , Rochester, Minnesota
| | - Ananda Basu
- Endocrine Research Unit, Division of Endocrinology and Metabolism, Mayo Clinic , Rochester, Minnesota
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19
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Rachmiel M, Landau Z, Boaz M, Mazor Aronovitch K, Loewenthal N, Ben-Ami M, Levy-Shraga Y, Modan-Moses D, Haim A, Abiri S, Pinhas-Hamiel O. The use of continuous glucose monitoring systems in a pediatric population with type 1 diabetes mellitus in real-life settings: the AWeSoMe Study Group experience. Acta Diabetol 2015; 52:323-9. [PMID: 25223531 DOI: 10.1007/s00592-014-0643-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/21/2014] [Indexed: 02/06/2023]
Abstract
AIMS The aim of the study was (a) to compare annual glycemic control in pediatric patients with type 1 diabetes mellitus (T1DM) who used a healthcare-funded continuous glucose monitoring system (RT-CGMS) to that of those who performed self-monitoring blood glucose (SMBG) only, in a real-life setting, and (b) to define parameters associated with compliance and glycemic control. METHODS A total of 149 youth with T1DM (52.3 % females), mean age 11.8 ± 3.6 years, and 83 in the CGMS group were followed prospectively for 12 months. Glycemic control parameters and compliance to RT-CGMS were assessed periodically. RESULTS Glycemic parameters did not differ significantly between the groups during follow-up periods. The time spent with RT-CGMS decreased and only 38 % used it for more than 75 % of the time during the 12 months (consistent users). Mean HbA1c decreased by 0.27 % in consistent users and increased by 0.21 % among intermittent users (used RT-CGMS less than 75 % of time), p = 0.013. Consistent users were younger 10. 6 ± 4.2 vs. 12.5 ± 3.6, p = 0.07, and had higher frequency of SMBG at baseline, 10.6 ± 4.9 vs. 6.3 ± 2.8, p = 0.011. CONCLUSIONS The adoption of RT-CGMS was low, even in a healthcare system that funds its use. Caregivers should consider patient characteristics when recommending RT-CGMS use.
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Affiliation(s)
- M Rachmiel
- Pediatric and Adolescent Diabetes Mellitus Service, Assaf Harofeh Medical Center, 70300, Zerifin, Israel,
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20
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Unger J, Parkin C. Hypoglycemia in Insulin-Treated Diabetes: A Case for Increased Vigilance. Postgrad Med 2015; 123:81-91. [DOI: 10.3810/pgm.2011.07.2307] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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21
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Tumminia A, Sciacca L, Frittitta L, Squatrito S, Vigneri R, Le Moli R, Tomaselli L. Integrated insulin pump therapy with continuous glucose monitoring for improved adherence: technology update. Patient Prefer Adherence 2015; 9:1263-70. [PMID: 26379428 PMCID: PMC4567238 DOI: 10.2147/ppa.s69482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Insulin pump therapy combined with real-time continuous glucose monitoring, known as sensor-augmented pump (SAP) therapy, has been shown to improve metabolic control and to reduce the rate of hypoglycemia in adults with type 1 diabetes compared to multiple daily injections or standard continuous subcutaneous insulin infusion. Glycemic variability is also reduced in patients on SAP therapy. This approach allows patients to monitor their glucose levels being informed of glycemic concentration and trend. Trained diabetic patients, therefore, can appropriately modify insulin infusion and/or carbohydrate intake in order to prevent hypo- or hyperglycemia. For these reasons, SAP therapy is now considered the gold standard for type 1 diabetes treatment. To be clinically effective, however, devices and techniques using advanced technology should not only have the potential to theoretically ameliorate metabolic control, but also be well accepted by patients in terms of satisfaction and health-related quality of life, because these factors will improve treatment adherence and consequently overall outcome. SAP therapy is generally well tolerated by patients; however, many clinical trials have identified significant noncompliance in the use of this device, most notably in the pediatric and adolescent populations. In this review we aim to analyze the main reasons for good or poor adherence to SAP therapy and to provide useful tips in order to fully benefit from this kind of novel therapeutic approach.
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Affiliation(s)
- Andrea Tumminia
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - Laura Sciacca
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - Lucia Frittitta
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - Sebastiano Squatrito
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | | | - Rosario Le Moli
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
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22
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Hommel E, Olsen B, Battelino T, Conget I, Schütz-Fuhrmann I, Hoogma R, Schierloh U, Sulli N, Gough H, Castañeda J, de Portu S, Bolinder J. Impact of continuous glucose monitoring on quality of life, treatment satisfaction, and use of medical care resources: analyses from the SWITCH study. Acta Diabetol 2014; 51:845-51. [PMID: 25037251 PMCID: PMC4176956 DOI: 10.1007/s00592-014-0598-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/15/2014] [Indexed: 11/12/2022]
Abstract
To investigate the impact of continuous glucose monitoring (CGM) on health-related quality of life (HRQOL), treatment satisfaction (TS) medical resource use, and indirect costs in the SWITCH study. SWITCH was a multicentre, randomized, crossover study. Patients with type 1 diabetes (n = 153) using continuous subcutaneous insulin infusion (CSII) were randomized to a 12 month sensor-On/Off or sensor-Off/On sequence (6 months each treatment), with a 4-month washout between periods. HRQOL in children and TS in adults were measured using validated questionnaires. Medical resource utilization data were collected. In adults, TS was significantly higher in the sensor-On arm, and there were significant improvements in ratings for treatment convenience and flexibility. There were no clinically significant differences in children's HRQOL or parents' proxy ratings. The incidence of severe hypoglycaemia, unscheduled visits, or diabetes-related hospitalizations did not differ significantly between the two arms. Adult patients made fewer telephone consultations during the sensor-On arm; children's caregivers made similar numbers of telephone consultations during both arms, and calls were on average only 3 min longer during the sensor-On arm. Regarding indirect costs, children with >70 % sensor usage missed fewer school days, compared with the sensor-Off arm (P = 0.0046) but there was no significant difference in the adults days of work off. The addition of CGM to CSII resulted in better metabolic control without imposing an additional burden on the patient or increased medical resource use, and offered the potential for cost offsets.
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Affiliation(s)
- E. Hommel
- Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Copenhagen, Denmark
| | - B. Olsen
- Herlev University Hospital, Copenhagen, Denmark
| | - T. Battelino
- University Children’s Hospital, University of Ljubljana, Ljubljana, Slovenia
| | - I. Conget
- Diabetes Unit, ICMDM Hospital Clínic i Universitari, Barcelona, Spain
| | | | - R. Hoogma
- Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - U. Schierloh
- Centre Hospitalier de Luxembourg, Clinique Pediatrique, Luxembourg, Luxembourg
| | - N. Sulli
- Clinica Pediatrica, Servizio Diabetologia, Policlinico Umberto I, Rome, Italy
| | - H. Gough
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - J. Castañeda
- Medtronic Bakken Research Centre, Maastricht, The Netherlands
| | - S. de Portu
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - J. Bolinder
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
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23
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Rewers MJ, Pillay K, de Beaufort C, Craig ME, Hanas R, Acerini CL, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2014. Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes 2014; 15 Suppl 20:102-14. [PMID: 25182311 DOI: 10.1111/pedi.12190] [Citation(s) in RCA: 218] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 06/16/2014] [Indexed: 12/24/2022] Open
Affiliation(s)
- Marian J Rewers
- Barbara Davis Center, University of Colorado Denver, Aurora, CO, USA
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24
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Little SA, Leelarathna L, Barendse SM, Walkinshaw E, Tan HK, Lubina Solomon A, de Zoysa N, Rogers H, Choudhary P, Amiel SA, Heller SR, Evans M, Flanagan D, Speight J, Shaw JAM. Severe hypoglycaemia in type 1 diabetes mellitus: underlying drivers and potential strategies for successful prevention. Diabetes Metab Res Rev 2014; 30:175-90. [PMID: 24185859 DOI: 10.1002/dmrr.2492] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 10/23/2013] [Accepted: 10/25/2013] [Indexed: 02/03/2023]
Abstract
Hypoglycaemia remains an over-riding factor limiting optimal glycaemic control in type 1 diabetes. Severe hypoglycaemia is prevalent in almost half of those with long-duration diabetes and is one of the most feared diabetes-related complications. In this review, we present an overview of the increasing body of literature seeking to elucidate the underlying pathophysiology of severe hypoglycaemia and the limited evidence behind the strategies employed to prevent episodes. Drivers of severe hypoglycaemia including impaired counter-regulation, hypoglycaemia-associated autonomic failure, psychosocial and behavioural factors and neuroimaging correlates are discussed. Treatment strategies encompassing structured education, insulin analogue regimens, continuous subcutaneous insulin infusion pumps, continuous glucose sensing and beta-cell replacement therapies have been employed, yet there is little randomized controlled trial evidence demonstrating effectiveness of new technologies in reducing severe hypoglycaemia. Optimally designed interventional trials evaluating these existing technologies and using modern methods of teaching patients flexible insulin use within structured education programmes with the specific goal of preventing severe hypoglycaemia are required. Individuals at high risk need to be monitored with meticulous collection of data on awareness, as well as frequency and severity of all hypoglycaemic episodes.
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Affiliation(s)
- S A Little
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
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25
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Ritholz MD, Beste M, Edwards SS, Beverly EA, Atakov-Castillo A, Wolpert HA. Impact of continuous glucose monitoring on diabetes management and marital relationships of adults with Type 1 diabetes and their spouses: a qualitative study. Diabet Med 2014; 31:47-54. [PMID: 23819557 DOI: 10.1111/dme.12276] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2013] [Indexed: 11/28/2022]
Abstract
AIMS To examine the impact of continuous glucose monitoring on diabetes management and marital relationships of adults with Type 1 diabetes and their spouses. METHODS Nine younger (30-49 years) and 11 older (50-70 years) patients with Type 1 diabetes and 14 spouses participated in eight focus groups specific to age and role (patient or spouse). Audio-recorded data were transcribed, coded and analysed using thematic analysis and aided by NVivo software. RESULTS Qualitative analysis revealed participants perceived continuous glucose monitoring as positively influencing hypoglycaemia management by decreasing spouses' anxiety, vigilance and negative experiences. Participants also described continuous glucose monitoring as promoting collaborative diabetes management and increasing spousal understanding of diabetes, especially when planning and managing pregnancy. Couples' conflicts occurred when (1) patients assumed sole responsibility for continuous glucose monitoring and/or did not respond to night-time glucose alarms and (2) spouses did not understand alarms and felt frustrated and helpless to assist patients. CONCLUSIONS Our findings suggest that continuous glucose monitoring may positively impact collaborative diabetes management and marital relationships of patients with Type 1 diabetes and their spouses. However, reluctance to collaborate and lack of understanding may contribute to couples' conflicts around continuous glucose monitoring. Our findings have important implications for clinical care and point to the need for interventions that include spouses in continuous glucose monitoring training to increase their understanding of continuous glucose monitoring, minimize risk for spousal conflict and enhance collaborative diabetes management. Further studies are needed to explore these issues in more detail and depth with larger and more diverse populations.
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Affiliation(s)
- M D Ritholz
- Behavioral Mental Health, Joslin Diabetes Center; Department of Psychiatry, Harvard Medical School; Department of Psychiatry, Boston Children's Hospital
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26
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Abstract
During the last several decades, a proliferation of sophisticated technology has taken place to facilitate diabetes self-management and improve health outcomes. Blood glucose monitors, insulin pumps, and continuous glucose monitors have significant data storage capacity, which can be used to summarize diabetes health management and outcomes. In the absence of technology errors or failures, and in the context of the multiple psychosocial factors associated with nonadherence, these data have the potential to elucidate diabetes care because they reflect actual patient behaviors. This review provides a summary of the diabetes adherence literature in the context of current American Diabetes Association Clinical Practice Recommendations with a focus on studies that have used objective methods (ie, data derived from technology) to assess diabetes care provider and patient adherence in the areas of glucose monitoring; insulin administration and antihyperglycemic medications; medical nutrition therapy; and physical activity.
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Affiliation(s)
- Kimberly A Driscoll
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL, 32306-4300, USA,
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27
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Monthly use of a real-time continuous glucose monitoring system as an educational and motivational tool for poorly controlled type 1 diabetes adolescents. Adv Med Sci 2013; 58:344-52. [PMID: 23917476 DOI: 10.2478/ams-2013-0024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Experience with the use of real-time continuous glucose monitoring systems (RT-CGMS) in teenagers with type 1 diabetes mellitus (T1DM) is limited. We aimed to assess the possibility of glycaemic control improvement and to characterize the group of adolescents, who may gain long-term benefits from the use of the RT-CGMS. METHODS Forty T1DM patients, aged 14.6 ± 2.1 years, with diabetes duration 7.4 ± 3.6 years and initial HbA₁c 9.3 ± 1.5% were recruited. The analysis was based on one-month glucose sensors use, combined with the thorough family support. Patients were analysed in groups according to baseline HbA₁c: below and above 7.5%, and 10.0%. Comparison between patients with or without improvement in HbA₁c after 3-month follow-up was also performed. Patients' satisfaction based on the questionnaire was assessed. RESULTS HbA₁c level in entire study group decreased after three months, from 9.3 ± 1.0% to 8.8 ± 1.6% (P<0.001). In the group with HbA1c improvement, reduction was the highest: 9.0 ± 1.3% vs. 8.0 ± 1.2% (P<0.001). Only the group with initial HbA₁c>10% did not achieve significant improvement: 11.2 ± 0.5% vs. 10.9 ± 1.1 (P=0.06). In satisfaction questionnaire the lowest scores (negative opinion) were reported by group of patients with initial HbA₁c above 10%, while the highest scores (positive opinion) were found in the group with improvement of HbA₁c after 3 month follow-up. CONCLUSION Short-term use of CGMS RT, united with satisfaction questionnaire, performed in poorly controlled teenagers with T1DM, can be useful in defining the group of young patients, who can benefit from long-term CGMS RT use in metabolic control improvement.
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28
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The role of continuous glucose monitoring in the care of children with type 1 diabetes. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2013; 2013:8. [PMID: 23531400 PMCID: PMC3630059 DOI: 10.1186/1687-9856-2013-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 03/20/2013] [Indexed: 11/10/2022]
Abstract
Continuous glucose monitoring (CGM), while a relatively new technology, has the potential to transform care for children with type 1 diabetes. Some, but not all studies, have shown that CGM can significantly improve hemoglobin A1c levels and reduce time spent in the hypoglycemic range in children, particularly when used as part of sensor-augmented pump (SAP) therapy. Despite the publication of recent clinical practice guidelines suggesting CGM be offered to all children 8 years of age or older who are likely to benefit, and studies showing that younger children can also benefit, this technology is not yet commonly used by children with type 1 diabetes. Effects of CGM are enhanced when used on a near-daily basis (a use-dependent effect) and with insulin pump therapy. Therefore, coordinated strategies are needed to help children and their families initiate and continue to use this resource for diabetes care. This review introduces CGM to pediatric endocrinologists who are not yet familiar with the finer details of this technology, summarizes current data showing the benefits and limitations of CGM use in children, reviews specific case examples demonstrating when CGM can be helpful, and shows the value of both retrospective and real-time CGM. It is hoped that this information leads to discussion of this technology in pediatric endocrinology clinics as an important next step in improving the care of children with type 1 diabetes.
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29
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Wolbring G, Leopatra V. Sensors: views of staff of a disability service organization. J Pers Med 2013; 3:23-39. [PMID: 25562409 PMCID: PMC4251385 DOI: 10.3390/jpm3010023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/05/2013] [Accepted: 02/07/2013] [Indexed: 11/16/2022] Open
Abstract
Sensors have become ubiquitous in their reach and scope of application. They are a technological cornerstone for various modes of health surveillance and participatory medicine-such as quantifying oneself; they are also employed to track people with certain as impairments perceived ability differences. This paper presents quantitative and qualitative data of an exploratory, non-generalizable study into the perceptions, attitudes and concerns of staff of a disability service organization, that mostly serve people with intellectual disabilities, towards the use of various types of sensor technologies that might be used by and with their clients. In addition, perspectives of various types of privacy issues linked to sensors, as well data regarding the concept of quantified self were obtained. Our results highlight the need to involve disabled people and their support networks in sensor and quantified-self discourses, in order to prevent undue disadvantages.
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Affiliation(s)
- Gregor Wolbring
- Department Community Health Sciences, Faculty of Medicine, Stream of Community Rehabilitation and Disability Studies, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada.
| | - Verlyn Leopatra
- Bachelor of Health Sciences, Faculty of Medicine, University of Calgary 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada.
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Benhamou PY, Catargi B, Delenne B, Guerci B, Hanaire H, Jeandidier N, Leroy R, Meyer L, Penfornis A, Radermecker RP, Renard E, Baillot-Rudoni S, Riveline JP, Schaepelynck P, Sola-Gazagnes A, Sulmont V, Tubiana-Rufi N, Durain D, Mantovani I, Sola-Gazagnes A, Riveline JP. Real-time continuous glucose monitoring (CGM) integrated into the treatment of type 1 diabetes: consensus of experts from SFD, EVADIAC and SFE. DIABETES & METABOLISM 2012; 38 Suppl 4:S67-83. [PMID: 22980520 DOI: 10.1016/s1262-3636(12)71538-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- P-Y Benhamou
- Service Endocrinologie-Diabétologie-Nutrition, CHU Grenoble, et Université Grenoble-1, France
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Abstract
Ensuring quality of life (QOL) while maintaining glycemic control within targets is an important challenge in type 1 and type 2 diabetes treatment. For children with diabetes, QOL includes enjoying meals, feeling safe in school, and perceiving positive, supportive relationships with parents, siblings, and friends. Yet many treatment-related and psychosocial barriers can interfere with a child's QOL and their ability to manage diabetes effectively. Diabetes management also imposes considerable lifestyle demands that are difficult and often frustrating for children to negotiate at a young age. Recent advances in diabetes medications and technologies have improved glycemic control in children with diabetes. Two widely used technologies are the insulin pump and continuous glucose monitoring (CGM) system. These technologies provide patients with more flexibility in their daily life and information about glucose fluctuations. Several studies report improvements in glycemic control in children with type 1 diabetes using the insulin pump or sensor-augmented pump therapy. Importantly, these technologies may impact QOL for children and families with diabetes, although they are rarely used or studied in the treatment of children with type 2 diabetes. Further, emerging closed loop and web- and phone-based technologies have great potential for supporting diabetes self-management and perhaps QOL. A deeper understanding and appreciation of the impact of diabetes technology on children's and parents' QOL is critical for both the medical and psychological care of diabetes. Thus, the purpose of this review is to discuss the impact of new diabetes technologies on QOL in children, adolescents and families with type 1 diabetes.
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Affiliation(s)
- Masakazu Hirose
- Joslin Diabetes Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elizabeth A. Beverly
- Joslin Diabetes Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Katie Weinger
- Joslin Diabetes Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Thorpe CT, Fahey LE, Johnson H, Deshpande M, Thorpe JM, Fisher EB. Facilitating healthy coping in patients with diabetes: a systematic review. DIABETES EDUCATOR 2012; 39:33-52. [PMID: 23073967 DOI: 10.1177/0145721712464400] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this study is to summarize recent literature on approaches to supporting healthy coping in diabetes in 2 specific areas: (1) the impact of different approaches to diabetes treatment on healthy coping and (2) the effectiveness of interventions specifically designed to support healthy coping. METHODS A PubMed search identified 129 articles published August 1, 2006, to April 30, 2011, addressing diabetes in relation to emotion, quality of life, depression, adjustment, anxiety, coping, family therapy, behavior therapy, psychotherapy, problem solving, couples therapy, or marital therapy. RESULTS Evidence suggests that treatment choice may significantly influence quality of life, with treatment intensification in response to poor metabolic control often improving quality of life. The recent literature provides support for a variety of healthy coping interventions in diverse populations, including diabetes self-management education, support groups, problem-solving approaches, and coping skills interventions for improving a range of outcomes; cognitive behavior therapy and collaborative care for treating depression; and family therapy for improving coping in youths. CONCLUSIONS Healthy coping in diabetes has received substantial attention in the past 5 years. A variety of approaches show positive results. Research is needed to compare the effectiveness of different approaches in different populations and determine how to overcome barriers to intervention dissemination and implementation.
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Affiliation(s)
- Carolyn T Thorpe
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (Dr C. Thorpe, Dr J. Thorpe),University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania (Dr C. Thorpe, Dr J. Thorpe)
| | - Lauren E Fahey
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Ms Fahey)
| | - Heather Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Dr Johnson)
| | - Maithili Deshpande
- University of Wisconsin School of Pharmacy, Madison, Wisconsin (Ms Deshpande)
| | - Joshua M Thorpe
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (Dr C. Thorpe, Dr J. Thorpe),University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania (Dr C. Thorpe, Dr J. Thorpe)
| | - Edwin B Fisher
- University of North Carolina School of Public Health, Chapel Hill, North Carolina (Dr Fisher)
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Wang C, Lv L, Yang Y, Chen D, Liu G, Chen L, Song Y, He L, Li X, Tian H, Jia W, Ran X. Glucose fluctuations in subjects with normal glucose tolerance, impaired glucose regulation and newly diagnosed type 2 diabetes mellitus. Clin Endocrinol (Oxf) 2012; 76:810-5. [PMID: 21854404 DOI: 10.1111/j.1365-2265.2011.04205.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Glycemic variability is poorly studied in the nondiabetic individuals and newly diagnosed patients with type 2 diabetes. The aim of the study is to investigate the characteristics of glucose fluctuations in subjects with normal glucose tolerance (NGT), impaired glucose regulation (IGR) and newly diagnosed, drug-naïve type 2 diabetes mellitus (DM-2). DESIGN AND PATIENTS This is a cross-sectional study of three groups including 53 subjects with IGR, 56 DM-2 patients and 53 NGT individuals. Monitoring by a continuous glucose monitoring system (CGMS(®) System Gold(™)) was performed for three consecutive days. MEASUREMENTS Mean blood glucose (MBG), standard deviation of MBG (SDBG), largest amplitude of glycemic excursions (LAGE) and mean amplitude of glycemic excursions (MAGE) were calculated to estimate intraday blood glucose variability. Interday variability of glucose was evaluated by absolute means of daily differences (MODD). Postprandial glucose excursion (PPGE) was calculated to assess the influence of meals on glucose fluctuation. RESULTS Twenty-two percentage of NGT and 33.9% of IGR individuals experienced blood glucose ≥ 11.1 mmol/l; 49.1% of NGT, 50.9% of IGR and 30.8% of DM-2 participants had hypoglycemic episodes (CGM values <3.9 mmol/l). The IGR and DM-2 groups had greater SDBG (P = 0.010 and P < 0.001), LAGE (P = 0.014 and P < 0.001) and MAGE (P = 0.044 and P < 0.001) compared with the NGT group. Significantly greater MODD and PPGEs were found in the DM-2 groups than in the IGR and NGT groups (P < 0.001). The DM-2 patients had higher 72-MBG and glucose levels overnight than the NGT and IGR subjects (P < 0.001). In the patients with diabetes, MAGE was positively associated with MODD (r = 0.558, P < 0.001) and PPGEs (r = 0.738-0.843, P < 0.001). CONCLUSIONS Glucose variability is present to an increasing degree from NGT to IGR and IGR to DM-2. Compared with the NGT individuals, the IGR and DM-2 subjects show more predominant intraday glucose fluctuations. The DM-2 patients demonstrate increased PPGEs, higher glucose levels overnight and greater interday fluctuations.
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Affiliation(s)
- Chun Wang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Sichuan, China
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YASUZAWA M, EDAGAWA K, MATSUNAGA T, TAKAOKA H, YABUTANI T. Highly Selective Needle-Type Glucose Sensors Prepared by the Immobilization of Glucose Oxidase on .GAMMA.-Polyglutamic Acid Film. ANAL SCI 2011; 27:337-40. [DOI: 10.2116/analsci.27.337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mikito YASUZAWA
- Department of Chemical Science and Technology, Institute of Science and Technology, The University of Tokushima
| | - Kazuaki EDAGAWA
- Department of Chemical Science and Technology, Institute of Science and Technology, The University of Tokushima
| | - Takuya MATSUNAGA
- Department of Chemical Science and Technology, Institute of Science and Technology, The University of Tokushima
| | - Hiroki TAKAOKA
- Department of Chemical Science and Technology, Institute of Science and Technology, The University of Tokushima
- Toyo Precision Parts MFG. Co., Ltd
| | - Tomoki YABUTANI
- Department of Chemical Science and Technology, Institute of Science and Technology, The University of Tokushima
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