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Nwokolo M, Hovorka R. The Artificial Pancreas and Type 1 Diabetes. J Clin Endocrinol Metab 2023; 108:1614-1623. [PMID: 36734145 PMCID: PMC10271231 DOI: 10.1210/clinem/dgad068] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/23/2023] [Accepted: 02/01/2023] [Indexed: 02/04/2023]
Abstract
Diabetes technologies represent a paradigm shift in type 1 diabetes care. Continuous subcutaneous insulin infusion (CSII) pumps and continuous glucose monitors (CGM) improve glycated hemoglobin (HbA1c) levels, enhance time in optimal glycemic range, limit severe hypoglycemia, and reduce diabetes distress. The artificial pancreas or closed-loop system connects these devices via a control algorithm programmed to maintain target glucose, partially relieving the person living with diabetes of this constant responsibility. Automating insulin delivery reduces the input required from those wearing the device, leading to better physiological and psychosocial outcomes. Hybrid closed-loop therapy systems, requiring user-initiated prandial insulin doses, are the most advanced closed-loop systems commercially available. Fully closed-loop systems, requiring no user-initiated insulin boluses, and dual hormone systems have been shown to be safe and efficacious in the research setting. Clinical adoption of closed-loop therapy remains in early stages despite recent technological advances. People living with diabetes, health care professionals, and regulatory agencies continue to navigate the complex path to equitable access. We review the available devices, evidence, clinical implications, and barriers regarding these innovatory technologies.
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Affiliation(s)
- Munachiso Nwokolo
- Wellcome Trust-MRC Institute of Metabolic Science, Box 289, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, Box 289, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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2
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Sherr JL, Schoelwer M, Dos Santos TJ, Reddy L, Biester T, Galderisi A, van Dyk JC, Hilliard ME, Berget C, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Insulin delivery. Pediatr Diabetes 2022; 23:1406-1431. [PMID: 36468192 DOI: 10.1111/pedi.13421] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 12/11/2022] Open
Affiliation(s)
- Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Melissa Schoelwer
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Leenatha Reddy
- Department of Pediatrics Endocrinology, Rainbow Children's Hospital, Hyderabad, India
| | - Torben Biester
- AUF DER BULT, Hospital for Children and Adolescents, Hannover, Germany
| | - Alfonso Galderisi
- Department of Woman and Child's Health, University of Padova, Padova, Italy
| | | | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Cari Berget
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Linda A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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3
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Bombaci B, Passanisi S, Alibrandi A, D’Arrigo G, Patroniti S, Averna S, Salzano G, Lombardo F. One-Year Real-World Study on Comparison among Different Continuous Subcutaneous Insulin Infusion Devices for the Management of Pediatric Patients with Type 1 Diabetes: The Supremacy of Hybrid Closed-Loop Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610293. [PMID: 36011925 PMCID: PMC9408433 DOI: 10.3390/ijerph191610293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 05/30/2023]
Abstract
Since their advent in daily clinical practice, continuous subcutaneous insulin infusion (CSII) systems have been increasingly improved, leading to a high percentage of both adult and pediatric patients with diabetes now using insulin pumps. Different types of CSII systems are currently available, which are characterized by different settings and technical features. This longitudinal observational study aims to evaluate real-word glycemic outcomes in children and adolescents with type 1 diabetes using three different CSII devices: hybrid closed-loop (HCL) systems, predictive low glucose (PLGS) systems, and non-automated insulin pumps. The secondary objective was to identify clinical variables that may significantly influence the achievement of therapeutic goals in our study cohort. One-hundred-and-one patients on CSII therapy attending our pediatric diabetes center were enrolled. When compared with the non-automated group, patients using HCL systems showed higher levels of time in target glucose range (p = 0.003) and lower glucose variability (p = 0.008). Similarly, we found significantly better glucose metrics in HCL users in comparison to PLGS patients (time in range p = 0.008; coefficient of variation p = 0.009; time above 250 mg/dL p = 0.007). Multiple linear regression models showed that HCL systems (time in range p < 0.001) and high daily percentage of glycemic sensor use (time in range p = 0.031) are predictors for good glycemic control. The introduction and increasing availability of novel technologies for diabetes represent a promising strategy to improve glycemic control and quality of life in pediatric patients with type 1 diabetes. Our real-world data confirm the superiority of HCL systems in terms of improvement of time spent in the target glucose range, prevention of hypoglycemia, and reduction of glycemic variability.
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Affiliation(s)
- Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Angela Alibrandi
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, 98124 Messina, Italy
| | - Giulia D’Arrigo
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Serena Patroniti
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Simona Averna
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
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4
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Alvarenga CS, La Banca RO, Neris RR, de Cássia Sparapani V, Fuentealba-Torres M, Cartagena-Ramos D, Leal CL, Esper MV, Nascimento LC. Use of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes mellitus: a systematic mapping review. BMC Endocr Disord 2022; 22:43. [PMID: 35183150 PMCID: PMC8858488 DOI: 10.1186/s12902-022-00950-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/24/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Among the treatments for type 1 diabetes mellitus (T1DM), Continuous Subcutaneous Insulin Infusion (CSII) is a device that infuses insulin through the subcutaneous tissue in an uninterrupted manner and that comes closest to the physiological secretion of insulin. The use of CSII can provide the family with greater security and children and adolescents have more autonomy in relation to the treatment of T1DM. There is a lack of reviews that systematically gather the mounting evidence about the use of CSII in children and adolescents with T1DM. Therefore, the aim of this review was to group and describe primary and secondary studies on the use of CSII in children and adolescents with T1DM. METHODS A systematic mapping review was performed based on searches in the following databases: PubMed, Embase, CINAHL, Lilacs and PsycINFO, using a combination of descriptors and keywords. The screening of the studies was carried out with the aid of the Rayyan software and reading in full was conducted independently by two reviewers. The data extraction of the studies was performed using an extraction tool adapted and validated by researchers specialized in diabetes. The data were analyzed according to the content analysis technique. The map from geocoding of the studies was produced using the ArcGis 10.5 software. RESULTS A total of 113 studies were included in the review, including primary studies, literature reviews and gray literature publications. The content analysis of the results of the studies allowed for the identification of four categories: 1) metabolic control; 2) support networks; 3) benefits of using CSII; and 4) challenges of using CSII, each category having its respective subcategories. The review also made it possible to conduct a rigorous mapping of the literature on the use of CSII considering the location of development and the design of the studies. CONCLUSIONS The use of CSII should be indicated by health professionals able to prepare children, adolescents, and their families for the treatment of T1DM, and, despite being a technological device, it may not be suitable for the entire pediatric population.
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Affiliation(s)
- Carolina Spinelli Alvarenga
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP Brazil
| | | | - Rhyquelle Rhibna Neris
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP Brazil
| | | | | | | | - Camila Lima Leal
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP Brazil
| | - Marcos Venicio Esper
- Interunit Doctoral Program in Nursing, University of São Paulo College of Nursing and the University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP Brazil
| | - Lucila Castanheira Nascimento
- Maternal-Infant and Public Health Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, PAHO/WHO Collaborating Centre for Nursing Research Development, 3900 Av. Bandeirantes, Campus Universitário - Bairro Monte Alegre, Ribeirão Preto, São Paulo 14040-902 Brazil
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5
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Lombardo F, Passanisi S, Tinti D, Messina MF, Salzano G, Rabbone I. High Frequency of Dermatological Complications in Children and Adolescents with Type 1 Diabetes: A Web-Based Survey. J Diabetes Sci Technol 2021; 15:1377-1381. [PMID: 32757778 PMCID: PMC8655296 DOI: 10.1177/1932296820947072] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Despite advances in the management of type 1 diabetes (T1D), there is an increasing incidence of skin reactions related to diabetes devices such as patch pumps and glucose sensors. Aim of the present study was to assess the prevalence of dermatological complications in pediatric patients with T1D using technological devices. METHODS Online survey regarding skin reactions related to the use of patch pumps and/or glucose sensors was administered to families of children and adolescents (0-17 years) with T1D. Data were collected on demographic characteristics, duration of diabetes, and clinical features of dermatological complications if present. RESULTS Our study population consisted of 139 patients (female 51.8%) aged 11.1 ± 3.3 years. More than half (51.1%) experienced skin reactions due to patch pumps or glucose sensors. Dermatological complications were mainly caused by continuous glucose monitoring (56.3% of total). Timing of appearance of dermatological reactions varied from a few days to several months after the introduction of the device. The application of hypoallergenic barrier bandages was the most frequently adopted measure to solve the issue. CONCLUSIONS Our study confirmed high frequency of dermatological complications among pediatric patients with type 1 diabetes. Well-designed studies are awaited to provide clear recommendations to minimize the burden of skin issues related to technological devices.
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Affiliation(s)
- Fortunato Lombardo
- Department of Human Pathology in Adult
and Developmental Age, University of Messina, Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult
and Developmental Age, University of Messina, Messina, Italy
- Stefano Passanisi, Department of Human
Pathology in Adult and Developmental Age, University of Messina, Via Consolare
Valeria 1, Messina, 98124, Italy.
| | - Davide Tinti
- Department of Pediatrics, University of
Turin, Torino, Italy
| | - Maria Francesca Messina
- Department of Human Pathology in Adult
and Developmental Age, University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult
and Developmental Age, University of Messina, Messina, Italy
| | - Ivana Rabbone
- Department of Pediatrics, University of
Turin, Torino, Italy
- Department of Science of Health, Hub
Regional Center of Pediatric Diabetology, University of Oriental Piemonte, Novara,
Italy
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6
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Low-molecular-weight heparin administered by subcutaneous catheter is a safe and effective anti-coagulation regimen in selected inpatient infants and children with complex congenital heart disease. Cardiol Young 2021; 31:1439-1444. [PMID: 33588972 DOI: 10.1017/s1047951121000317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND/HYPOTHESIS Disadvantages of intravenous therapeutic unfractionated heparin, the first-line anti-coagulant agent in children with complex congenital heart disease, include unpredictable pharmacokinetics requiring frequent phlebotomies and the need for continuous intravenous access. OBJECTIVE To compare efficacy and safety of low-molecular-weight heparin administered by a subcutaneous indwelling catheter with intravenous unfractionated heparin. MATERIALS AND METHODS Clinical data from 31 inpatients prospectively enrolled to receive subcutaneous low-molecular-weight heparin were compared with those from a historical group of 44 inpatients receiving intravenous unfractionated heparin. Investigation of parents' satisfaction by telephone survey. RESULTS The percentage of anti-factor Xa levels outside therapeutic range was lower in the subcutaneous low-molecular-weight heparin group compared with the percentage of activated partial thromboplastin times outside therapeutic range in the intravenous unfractionated heparin group (40% versus 90%, p < 0.001). Neither group had a major complication. Transient local reactions occurred in 19% of patients of the subcutaneous low-molecular-weight heparin group. The number of needle punctures and that of placement of indwelling catheters were significantly lower in the subcutaneous low-molecular-weight heparin compared with the intravenous unfractionated heparin group (p < 0.001). In total, 84.2% of parents in the subcutaneous low-molecular-weight heparin group reported a positive experience when asked about comparison with prior intravenous unfractionated heparin treatment. CONCLUSION Subcutaneous low-molecular-weight heparin offers a safe anti-coagulation regimen for children with complex congenital heart disease providing more efficient therapeutic anti-coagulation and a reduction in needle punctures, thus causing less pain and anxiety in this children.
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7
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Ziegler R, Oliver N, Waldenmaier D, Mende J, Haug C, Freckmann G. Evaluation of the Accuracy of Current Tubeless Pumps for Continuous Subcutaneous Insulin Infusion. Diabetes Technol Ther 2021; 23:350-357. [PMID: 33210949 PMCID: PMC8080918 DOI: 10.1089/dia.2020.0525] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Recently two new tubeless pumps for insulin therapy were introduced. They were tested for accuracy and occlusion detection and compared with the established patch pump Omnipod® (OP). Methods: Using a modified setup for tubeless pumps based on IEC 60601-2-24, the basal rate and bolus delivery of the Accu-Chek® Solo micropump system (ACS) and the A6 TouchCare® System (A6) were measured with a microgravimetric method. Bolus sizes of 0.2, 1, and 10 U, and basal rates of 0.1 and 1 U/h were evaluated in nine repetitions. For each parameter, mean deviation and number of individual boluses or 1-h basal rate windows within ±15% from target were calculated. In addition, occlusion detection time at basal rates of 0.1 and 1 U/h was determined. Results: Mean deviation of boluses of different volumes in the pumps ranged from -3.3% to +4.0% and 40%-100% of individual boluses were within ±15% of the target. During basal rate delivery, 48% to 98% of 1-h windows were within ±15% of the target with a mean deviation between -5.3% and +6.5%. In general, considerable differences between pump models were observed and deviations decreased with increasing doses. In most parameters, ACS was more accurate, and A6 less accurate, than OP. Mean occlusion detection time ranged from ∼3 to 7.5 h at 1 U/h and was >24 h or absent at 0.1 U/h. Conclusions: In this evaluation, significant differences between the tested tubeless pump models were observed that became most evident when regarding delivery errors over short time and small volumes.
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Affiliation(s)
- Ralph Ziegler
- Diabetes Clinic for Children and Adolescents, Muenster, Germany
| | - Nick Oliver
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, United Kingdom
| | - Delia Waldenmaier
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Jochen Mende
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Cornelia Haug
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
- Address correspondence to: Guido Freckmann, MD, Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Lise-Meitner-Str. 8/2, Ulm 89081, Germany
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8
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Ziegler R, Waldenmaier D, Kamecke U, Mende J, Haug C, Freckmann G. Accuracy assessment of bolus and basal rate delivery of different insulin pump systems used in insulin pump therapy of children and adolescents. Pediatr Diabetes 2020; 21:649-656. [PMID: 32003490 DOI: 10.1111/pedi.12993] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/16/2020] [Accepted: 01/27/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Continuous subcutaneous insulin infusion (CSII) is commonly used in patients with diabetes. Accurate and reliable delivery by insulin pumps is essential for a safe and effective therapy, particularly when using small doses. In this study, accuracy of bolus and basal rate delivery of various available insulin pumps was evaluated. METHODS In total, 13 insulin pump systems were tested: eight durable pumps with different infusion sets and one patch pump. Based on IEC 60601-2-24, insulin delivery was measured by recording weight gain of a beaker into which insulin was infused by the pumps. Bolus accuracy was determined by individually weighing 25 consecutive 0.1 or 1.0 U boluses and basal rate accuracy was determined during basal rate delivery of 0.1 or 1.0 U/h for 72 hours. For analyses, basal rate delivery was divided into 1-hour windows and deviation from target was calculated. RESULTS Regarding different systems, average 0.1 U bolus delivery was -2% to +9% of the intended volume with 53% to 96% of boluses within ±15% of target. During 0.1 U/h basal rate delivery, most pumps showed an initial over-delivery for the first few hours. Three systems reached a total basal rate error <5%; others showed up to +24%. In general, delivery was more accurate when using larger doses. CONCLUSIONS Considerable differences in insulin delivery accuracy were observed between the tested pumps. In general, when using very low doses, accuracy of insulin delivery is limited in most insulin pumps. This should be considered for CSII therapy in children.
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Affiliation(s)
- Ralph Ziegler
- Diabetes Clinic for Children and Adolescents, Muenster, Germany
| | - Delia Waldenmaier
- Institut für Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Ulrike Kamecke
- Institut für Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Jochen Mende
- Institut für Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Cornelia Haug
- Institut für Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
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9
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Girardot S, Jacquemier P, Mousin F, Rendekeu C, Hardy S, Riveline JP. All Insulin Pumps Are Not Equivalent: A Bench Test Assessment for Several Basal Rates. Diabetes Technol Ther 2020; 22:476-483. [PMID: 32069066 DOI: 10.1089/dia.2019.0486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background and Aims: Continuous subcutaneous insulin infusion (CSII) is a widely adopted treatment for type 1 diabetes and is a component of an artificial pancreas. CSII accuracy is essential for glycemic control, however, this metric has not been given sufficient study, especially at the range of the lowest basal rates (BRs), which are commonly used in a pediatric population and in closed-loop systems (CLSs). Our study presents accuracy results of four off-the-shelf CSII systems using a new accurate method for CSII system evaluation. Materials and Methods: The accuracy of four off-the-shelf CSII systems was assessed: Medtronic MiniMed 640G®, Ypsomed YpsoPump®, Insulet Omnipod®, and Tandem t:slim X2®. The assessment was performed using a double-measurement approach through a direct mass flow meter and a time-stamped microgravimetric test bench combined with a Kalman mathematical filter. CSII accuracy was evaluated using mean of dose error. Mean absolute relative difference (MARD) of error was calculated at different observation windows over the whole series of tests. Peakwise insulin deliverance was assessed regarding stroke regularity in terms of frequency and volume. Results: Mean error values indicate a general tendency to underdeliver with up to -16%. MARD of error shows very wide results for each pump and each BR from 7.4% (2 UI/h) to 61.3% (0.1 UI/h). Peakwise analysis shows several choices for BR adaptation (frequency for Omnipod, volume for Tandem, both for YpsoPump and MiniMed 640G). Precision in interstroke time appears to be better (standard deviation [SD] at 0.1 UI/h: 4.6%-12.9%) than stroke volume precision (SD at 0.1 UI/h 38.3%-46.4%). Conclusions: The accuracy of four off-the-shelf CSII systems is model and BR dependent. CSII imprecision could be due to a variability in volume and/or frequency of strokes for every pump. Some models appear better adapted for the smallest insulin needs, or for inclusion in a CLS. The clinical implications of these delivery errors on glucose instability must be evaluated.
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Affiliation(s)
- Sylvain Girardot
- Air Liquide SA, Explor Center (Healthcare), Paris, Île-de-France, France
- IMMEDIAB Lab UMRS1138, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
- Université Paris Diderot-Paris VII, Paris, France
| | - Pauline Jacquemier
- Air Liquide SA, Explor Center (Healthcare), Paris, Île-de-France, France
- IMMEDIAB Lab UMRS1138, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
- Université Paris Diderot-Paris VII, Paris, France
| | - Flavien Mousin
- Air Liquide SA, Explor Center (Healthcare), Paris, Île-de-France, France
| | - Carine Rendekeu
- Air Liquide SA, Explor Center (Healthcare), Paris, Île-de-France, France
| | - Sébastien Hardy
- Air Liquide SA, Explor Center (Healthcare), Paris, Île-de-France, France
| | - Jean-Pierre Riveline
- IMMEDIAB Lab UMRS1138, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
- Université Paris Diderot-Paris VII, Paris, France
- Department of Diabetes and Endocrinology, Lariboisière Hospital, APHP, Paris, France
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10
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Ulbrich S, Waldenmaier D, Haug C, Freckmann G, Rendschmidt T, Künsting T. Concept and Implementation of a Novel Patch Pump for Insulin Delivery. J Diabetes Sci Technol 2020; 14:324-327. [PMID: 31452394 PMCID: PMC7196855 DOI: 10.1177/1932296819871626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
With the motivation to provide a small and discreet patch pump that complies with several customer needs, the recently CE-marked Accu-Chek® Solo micropump system was designed. The system consists of a tubeless insulin pump wirelessly controlled by the so-called diabetes manager. Via diabetes manager, basal rates and boluses are programmed; an integrated blood glucose meter and bolus calculator supports users in bolusing and offers several diary functions. The micropump features a quick bolus button for bolus initiation directly on the pump and is complemented by a disposable reservoir holding up to 200 U of rapid-acting insulin. The assembled pump is attached to the body via a pump holder containing soft cannula. The modular principle enables independent replacement of the single components if necessary.
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Affiliation(s)
- Sina Ulbrich
- Institut für Diabetes-Technologie,
Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Germany
| | - Delia Waldenmaier
- Institut für Diabetes-Technologie,
Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Germany
- Delia Waldenmaier, MSc, Institut für
Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der
Universität Ulm, Lise-Meitner-Str. 8/2, Ulm, Germany.
| | - Cornelia Haug
- Institut für Diabetes-Technologie,
Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie,
Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Germany
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11
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Nevo-Shenker M, Phillip M, Nimri R, Shalitin S. Type 1 diabetes mellitus management in young children: implementation of current technologies. Pediatr Res 2020; 87:624-629. [PMID: 31715623 DOI: 10.1038/s41390-019-0665-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/29/2019] [Accepted: 10/13/2019] [Indexed: 12/11/2022]
Abstract
The use of advanced technologies for diabetes management is on the rise among pediatric patients with type 1 diabetes (T1D). Continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring, predictive low glucose suspend, hybrid closed-loop insulin delivery systems-all enable better diabetes management and glycemic control. However, when used by children, and especially very young children, specific aspects must be taken into consideration, including technical parameters, ease of use, parental stress, and satisfaction. The unique characteristics of T1D in children aged <6 years are reviewed and studies of the pros and cons of different technologies in this specific age group are presented. Addressing such issues when implementing advanced technologies among very young children with T1D will enable better diabetes management and will hopefully ease a tremendous burden of both children and families.
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Affiliation(s)
- Michal Nevo-Shenker
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Moshe Phillip
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Revital Nimri
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Shalitin
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Assessment of Safety and Glycemic Control During Football Tournament in Children and Adolescents With Type 1 Diabetes-Results of GoalDiab Study. Pediatr Exerc Sci 2019; 31:401-407. [PMID: 30955442 DOI: 10.1123/pes.2018-0264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess glycemic control and safety of children and adolescents with type 1 diabetes participating in a 2-day football tournament. METHODS In total, 189 children with type 1 diabetes from 11 diabetes care centers, in Poland, participated in a football tournament in 3 age categories: 7-9 (21.2%), 10-13 (42.9%), and 14-17 (36%) years. Participants were qualified and organized in 23 football teams, played 4 to 6 matches of 30 minutes, and were supervised by a medical team. Data on insulin dose and glycemia were downloaded from personal pumps, glucose meters, continuous glucose monitoring, and flash glucose monitoring systems. RESULTS The median level of blood glucose before the matches was 6.78 (4.89-9.39) mmol/L, and after the matches, it was 7.39 (5.5-9.87) mmol/L (P = .001). There were no episodes of severe hypoglycemia or ketoacidosis. The number of episodes of low glucose value (blood glucose ≤3.9 mmol/L) was higher during the tournament versus 30 days before: 1.2 (0-1.5) versus 0.7 (0.3-1.1) event/person/day, P < .001. Lactate levels increased during the matches (2.2 [1.6-4.0] mmol/L to 4.4 [2.6-8.5] mmol/L after the matches, P < .001). CONCLUSIONS Large football tournaments can be organized safely for children with type 1 diabetes. For the majority of children, moderate mixed aerobic-anaerobic effort did not adversely affect glycemic results and metabolic safety.
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13
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Girardot S, Mousin F, Vezinet J, Jacquemier P, Hardy S, Riveline JP. Kalman Filter-Based Novel Methodology to Assess Insulin Pump Accuracy. Diabetes Technol Ther 2019; 21:557-565. [PMID: 31335164 DOI: 10.1089/dia.2019.0147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Insulin pump or continuous subcutaneous insulin infusion (CSII) system is a widely adopted contemporary treatment for type 1 diabetes and is a major component of an artificial pancreas (AP). CSII accuracy is essential for glycemic control and to-date such metric has not been given sufficient study, especially at the range of the lowest basal rate. The gold-standard assessment method IEC (International Electrotechnical Commission) 60601-2-24 has some limitations. Our study presents a new accurate and reactive method for CSII system evaluation based on direct flow measurement. Materials and Methods: A leading-edge assessment method based on a double measurement approach utilizing a direct mass flow meter and a time-stamped microgravimetric bench test was combined with a Bayesian-based mathematical filter (Kalman). The performance of this new method was evaluated while assessing the delivery precision of an off-the-shelf insulin pump at several basal rates. The proposed methodology offers a double reading-volume and flow rate-which provides direct instantaneous flow rate. CSII dose errors were evaluated using mean absolute relative dispersion (MARD) at different time intervals windows over the whole test. Results: The metrological aspect of the measurements and filtering performance were consistent. CSII precision is shown to be different in terms of the flow rate value: MARD15min (2 UI/h) = 12.7%, MARD15min (0.5 UI/h) = 20.4%, and MARD15min (0.1 UI/h) = 65.0%. MARD240min (2 UI/h) = 8.1%, (0.5 UI/h), MARD240min (0.5 UI/h) = 18.8%, and MARD240min (0.1 UI/h) = 18.4%. Instantaneous flow rate results highlight an irregular stroke-based delivery. Conclusion: This new method to assess insulin pump administration has been validated and highlights the current imprecision in insulin delivery, especially for the lowest basal rate, which is mainly used in pediatric cases and AP system delivery. This leading-edge method should be used to precisely compare several CSII performances in those contexts.
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Affiliation(s)
- Sylvain Girardot
- Air Liquide Healthcare, Explor Center, Gentilly, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Paris, France
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | | | - Jérémy Vezinet
- ENAC, SIGNAV Research Group, Toulouse, Midi-Pyrénées, France
| | | | | | - Jean-Pierre Riveline
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Paris, France
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
- Department of Diabetes and Endocrinology, Lariboisière Hospital, APHP, Paris, France
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14
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Schütz-Fuhrmann I, Stadler M, Zlamal-Fortunat S, Rami-Merhar B, Fröhlich-Reiterer E, Hofer SE, Mader J, Resl M, Bischof M, Kautzky-Willer A, Weitgasser R. [Insulin pump therapy in children, adolescents and adults, guidelines (Update 2019)]. Wien Klin Wochenschr 2019; 131:47-53. [PMID: 30980146 DOI: 10.1007/s00508-019-1485-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This position statement is based on current evidence available on the safety and benefits of continuous subcutaneous insulin infusion therapy (CSII, pump therapy) in diabetes with an emphasis on the effects of CSII on glycemic control, hypoglycaemia rates, occurrence of ketoacidosis, quality of life and the use of insulin pump therapy in pregnancy. The current article represents the recommendations of the Austrian Diabetes Association for the clinical praxis of insulin pump treatment in children, adolescents and adults.
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Affiliation(s)
- Ingrid Schütz-Fuhrmann
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Krankenhaus Hietzing, Wolkersbergenstraße 1, 1130, Wien, Österreich.
| | - Marietta Stadler
- Diabetes Research Group, King's College London, London, Großbritannien
| | - Sandra Zlamal-Fortunat
- Abteilung für Innere Medizin und Gastroenterologie, Klinikum Klagenfurt, Klagenfurt am Wörthersee, Österreich
| | - Birgit Rami-Merhar
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Elke Fröhlich-Reiterer
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Sabine E Hofer
- Department für Pädiatrie 1, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Julia Mader
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Michael Resl
- Abteilung für Innere Medizin I, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | | | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Raimund Weitgasser
- Abteilung für Innere Medizin, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich.,Universitätsklinik für Innere Medizin I, LKH Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
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15
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Laubner K, Singler E, Straetener J, Siegmund T, Päth G, Seufert J. Comparative Dose Accuracy of Durable and Patch Insulin Pumps Under Laboratory Conditions. Diabetes Technol Ther 2019; 21:371-378. [PMID: 31149838 DOI: 10.1089/dia.2019.0089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Recent studies demonstrate variable results of the accuracy with which patch pumps infuse insulin. Aim of this evaluation was to measure dose accuracies of the patch pump mylife™ OmniPod® (OP) in comparison with the durable insulin pump MiniMed® 640G (MM) simulating real-life clinical situations under laboratory conditions. Methods: Thirty-two OP and 15 MM were tested using insulin aspart at five different boluses (0.5, 1, 5, 10, and 15 international units [IU]) and three basal rates (0.2, 0.6, and 1.8 IU/h) at different time points during a 70 h investigation period. Owing to malfunctions only 22 OP and 11 MM could be analyzed. Dose accuracy was measured by an experimental setting based on IEC 60601-2-24:2012 with determination of weight differences of insulin collection tubes before and after experiments using a precision scale. A maximal tolerance of ±5% for boluses and basal rates was considered adequate according to IEC 60601-2-24:2012. Results: For the five boluses, the percentages of measurement results within the ±5% accuracy threshold were as follows: OP (18.6%, 26.5%, 89.0%, 96.0%, and 96.0%); MM (21.7%, 44.1%, 88.1%, 98.3%, and 100.0%). Both pumps were more accurate at higher bolus volumes (5, 10, and 15 IU), later bolus periods, and if the accuracy threshold was lowered to <10%, <15%, or >15%. For the three basal rates, the percentages within the ±5% accuracy threshold were as follows: OP (66.7%, 22.7%, and 16.7%); MM (14.3%, 0.0%, and 0.0%). Conclusion: This study demonstrates low accuracy for basal rates and single bolus deliveries at low insulin doses for both pump models. Clinicians should be aware of this variability when initiating insulin pump therapy especially in insulin-sensitive patients with low insulin dose requirements.
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Affiliation(s)
- Katharina Laubner
- 1 Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eva Singler
- 1 Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Straetener
- 1 Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thorsten Siegmund
- 2 Department of Endocrinology, Diabetology and Metabolism, Isar Klinikum, Munich, Germany
| | - Günter Päth
- 1 Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochen Seufert
- 1 Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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16
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Tauschmann M, Allen JM, Nagl K, Fritsch M, Yong J, Metcalfe E, Schaeffer D, Fichelle M, Schierloh U, Thiele AG, Abt D, Kojzar H, Mader JK, Slegtenhorst S, Barber N, Wilinska ME, Boughton C, Musolino G, Sibayan J, Cohen N, Kollman C, Hofer SE, Fröhlich-Reiterer E, Kapellen TM, Acerini CL, de Beaufort C, Campbell F, Rami-Merhar B, Hovorka R. Home Use of Day-and-Night Hybrid Closed-Loop Insulin Delivery in Very Young Children: A Multicenter, 3-Week, Randomized Trial. Diabetes Care 2019; 42:594-600. [PMID: 30692242 DOI: 10.2337/dc18-1881] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/18/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We aimed to assess the feasibility and safety of hybrid closed-loop insulin delivery in children with type 1 diabetes aged 1-7 years as well as evaluate the role of diluted insulin on glucose control. RESEARCH DESIGN AND METHODS In an open-label, multicenter, multinational, randomized crossover study, 24 children with type 1 diabetes on insulin pump therapy (median age 5 years [interquartile range 3-6] and mean ± SD HbA1c 7.4 ± 0.7% [57 ± 8 mmol/mol] and total insulin 13.2 ± 4.8 units/day) underwent two 21-day periods of unrestricted living and we compared hybrid closed-loop with diluted insulin (U20) and hybrid closed-loop with standard strength insulin (U100) in random order. During both interventions, the Cambridge model predictive control algorithm was used. RESULTS The proportion of time that sensor glucose was in the target range between 3.9 and 10 mmol/L (primary end point) was not different between interventions (mean ± SD 72 ± 8% vs. 70 ± 7% for closed-loop with diluted insulin vs. closed-loop with standard insulin, respectively; P = 0.16). There was no difference in mean glucose levels (8.0 ± 0.8 vs. 8.2 ± 0.6 mmol/L; P = 0.14), glucose variability (SD of sensor glucose 3.1 ± 0.5 vs. 3.2 ± 0.4 mmol/L; P = 0.16), or the proportion of time spent with sensor glucose <3.9 mmol/L (4.5 ± 1.7% vs. 4.7 ± 1.4%; P = 0.47) or <2.8 mmol/L (0.6 ± 0.5% vs. 0.6 ± 0.4%; P > 0.99). Total daily insulin delivery did not differ (17.3 ± 5.6 vs. 18.9 ± 6.9 units/day; P = 0.07). No closed-loop-related severe hypoglycemia or ketoacidosis occurred. CONCLUSIONS Unrestricted home use of day-and-night closed-loop in very young children with type 1 diabetes is feasible and safe. The use of diluted insulin during closed-loop does not provide additional benefits compared with standard strength insulin.
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Affiliation(s)
- Martin Tauschmann
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.,Department of Paediatrics, University of Cambridge, Cambridge, U.K.,Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Janet M Allen
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.,Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Katrin Nagl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Fritsch
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - James Yong
- Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds, U.K
| | - Emily Metcalfe
- Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds, U.K
| | - Dominique Schaeffer
- Department of Pediatric Diabetes and Endocrinology, Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Muriel Fichelle
- Department of Pediatric Diabetes and Endocrinology, Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Ulrike Schierloh
- Department of Pediatric Diabetes and Endocrinology, Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Alena G Thiele
- Division for Paediatric Diabetology, University of Leipzig, Leipzig, Germany
| | - Daniela Abt
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Kojzar
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Julia K Mader
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sonja Slegtenhorst
- Department of Nutrition and Dietetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, U.K
| | - Nicole Barber
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
| | - Malgorzata E Wilinska
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.,Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Charlotte Boughton
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
| | - Gianluca Musolino
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
| | | | | | | | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Thomas M Kapellen
- Division for Paediatric Diabetology, University of Leipzig, Leipzig, Germany
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Carine de Beaufort
- Department of Pediatric Diabetes and Endocrinology, Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Fiona Campbell
- Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds, U.K
| | - Birgit Rami-Merhar
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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17
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Petrovski G, Al Khalaf F, Hussain K, Campbell J, Awwa AE. Continuous Subcutaneous Insulin Infusion Characteristics in Type 1 Diabetes Children and Adolescents in Qatar. J Diabetes Sci Technol 2019; 13:144-145. [PMID: 30175592 PMCID: PMC6313295 DOI: 10.1177/1932296818796488] [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: 11/17/2022]
Affiliation(s)
- Goran Petrovski
- Sidra Medicine, Pediatrics, Endocrine and Diabetes Division, Doha, Qatar
- Goran Petrovski, MD, PhD, Sidra Medicine, Pediatrics, Endocrine and Diabetes Division, Office HB.6E-216, Al Luqta Street, Education City North Campus, Qatar Foundation, PO BOX 26999 - Doha, Qatar.
| | - Fawziya Al Khalaf
- Sidra Medicine, Pediatrics, Endocrine and Diabetes Division, Doha, Qatar
| | - Khalid Hussain
- Sidra Medicine, Pediatrics, Endocrine and Diabetes Division, Doha, Qatar
| | - Judith Campbell
- Sidra Medicine, Pediatrics, Endocrine and Diabetes Division, Doha, Qatar
| | - Ahmed El Awwa
- Sidra Medicine, Pediatrics, Endocrine and Diabetes Division, Doha, Qatar
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18
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Sherr JL, Tauschmann M, Battelino T, de Bock M, Forlenza G, Roman R, Hood KK, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes technologies. Pediatr Diabetes 2018; 19 Suppl 27:302-325. [PMID: 30039513 DOI: 10.1111/pedi.12731] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/10/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Martin Tauschmann
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Tadej Battelino
- UMC-University Children's Hospital, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Gregory Forlenza
- University of Colorado Denver, Barbara Davis Center, Aurora, Colorado
| | - Rossana Roman
- Medical Sciences Department, University of Antofagasta and Antofagasta Regional Hospital, Antofagasta, Chile
| | - Korey K Hood
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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19
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Petrovski G, Al Khalaf F, Hussain K, Campbell J, El Awwa A. Continuous Subcutaneous Insulin Infusion Characteristics in Type 1 Diabetes Children and Adolescents in Qatar. Diabetes Ther 2018; 9:2091-2098. [PMID: 30220038 PMCID: PMC6167275 DOI: 10.1007/s13300-018-0510-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Indexed: 11/26/2022] Open
Abstract
AIM To describe continuous subcutaneous insulin infusion (CSII) characteristics in type 1 diabetes mellitus (T1DM) children and adolescents using a standardized protocol in routine clinical settings in Qatar. METHODS A total of 138 T1DM patients (62 males; 76 females; mean age 9.8 ± 3.4 years) with a mean diabetes duration of 2.4 ± 1.9 years initiated CSII (MiniMed® Veo®™ and MiniMed® 640 G insulin pumps; Medtronic, Northridge, CA, USA) in 2016 and 2017. CSII characteristics and glycated hemoglobin (HbA1c) were evaluated 1 year after treatment initiation. RESULTS At 1 year after treatment initiation, the insulin dose had significantly increased (from 0.59 ± 0.23 to 0.74 ± 0.26 U/kg body weight per 24; P < 0.05), and the HbA1c level had significantly decreased (from 9.7 ± 1.3 to 8.1 ± 0.6%; P < 0.05). More than 92% of patients used the Bolus Wizard feature of the insulin pump at the following settings: insulin-to-carbohydrate ratio 19.2 ± 9.3 g; insulin sensitivity factor 131 ± 68 mg/dl; target range 91 ± 9.3-135 ± 14.2 mg/dl; active insulin time 3.8 ± 0.8 h. CONCLUSION Our results show that CSII may significantly improve glucose control in T1D children and adolescents who use a standardized protocol. A reduction of HbA1c by - 1.6% was achieved at 1 year after CSII initiation. These results need to be confirmed in a study with a longer duration.
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Affiliation(s)
- Goran Petrovski
- Pediatrics, Endocrine and Diabetes Division, Sidra Medicine, Doha, Qatar.
| | - Fawziya Al Khalaf
- Pediatrics, Endocrine and Diabetes Division, Sidra Medicine, Doha, Qatar
| | - Khalid Hussain
- Pediatrics, Endocrine and Diabetes Division, Sidra Medicine, Doha, Qatar
| | - Judith Campbell
- Pediatrics, Endocrine and Diabetes Division, Sidra Medicine, Doha, Qatar
| | - Ahmed El Awwa
- Pediatrics, Endocrine and Diabetes Division, Sidra Medicine, Doha, Qatar
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20
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Petrovski G, Zivkovic M. Continuous Subcutaneous Insulin Infusion and Its Characteristics in Young People with Type 1 Diabetes with Optimal Glucose Control (Preprint). JMIR Diabetes 2018. [DOI: 10.2196/10800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Ziegler R, Neu A. Diabetes in Childhood and Adolescence. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:146-156. [PMID: 29563012 PMCID: PMC5876549 DOI: 10.3238/arztebl.2018.0146] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/01/2017] [Accepted: 01/30/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND The incidence of type 1 diabetes mellitus in childhood and adolescence is steadily rising and now stands at 22.9 new cases per year per 100 000 persons up to age 15. METHODS This review is based on pertinent publications retrieved by a selective literature search, with special attention to the current German S3 guideline on diabetes in childhood and adolescence. RESULTS Polydipsia, polyuria, and weight loss are the characteristic presenting symptoms of diabetes mellitus. The acutely presenting patient needs immediate stabilization because of the danger of rapid metabolic decompensation (risk of keto - acidosis, 21.1%). Long-term insulin therapy can be delivered either by subcutaneous injection or by an insulin pump. The goals of treatment are the near-normalization of glucose metabolism (HbA1c <7.5%), the avoidance of acute complications (hypoglycemia and ketoacidosis), the reduction of diabetes-specific sequelae (retinopathy, nephropathy, neuropathy, hypertension, and hyperlipidemia), unrestricted participation in age-appropriate everyday activities, and normal physical and psychosocial development. Children and adolescents with diabetes need individualized treatment with frequent adjustments and holistic overall care so that these goals can be effectively met. CONCLUSION Every physician must be able to diagnose the initial presentation of diabetes and to initiate the first steps in its management. The patient should be referred as soon as possible to a diabetes team that has experience in the treatment of children and adolescents.
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22
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Petrovski G, Zivkovic M, Stratrova SS, Todorova BJ. Type 1 Diabetes and Long-Term Continuous Subcutaneous Insulin Infusion Therapy: A 10-Year Experience from Macedonia. Diabetes Technol Ther 2017; 19:739-743. [PMID: 28976785 DOI: 10.1089/dia.2017.0227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Subcutaneous insulin infusion (CSII) therapy is a challenge for both patients and healthcare providers. The long-term CSII use is scarce. The aim of this study is to describe the impact of CSII therapy for 10 years of use at our center. METHODS This single-center retrospective study includes 162 type 1 diabetes patients using CSII for >3 years during October 2004 until October 2014. Data were collected through the electronic medical record system, cross-sectional analysis (telephone, e-mail, or social media), and CSII reports generated by Carelink Therapy Management Software (Medtronic, Northridge, CA). RESULTS Patients were analyzed in three age groups: 12-18, 19-24, and >25 years. All patients were treated with CSII for >3 years. Total daily dose of insulin was >0.9 U/(kg·day) in age group 12-18 years old, which was significantly higher than other two age groups (P < 0.05). Basal ratio was lower in younger age (<40%) and showed trend of increasing with age and longer diabetes duration (up to 44%). Younger patients used bolus wizard on regular basis (>75%), which was significantly higher than other age groups (P < 0.05). More than 50% of patients achieved glycated hemoglobin (HbA1c) <7.0% and >70% of patients achieved HbA1c <7.5%. HbA1c level significantly changed from baseline in all groups (P < 0.05). CONCLUSION Our study shows improved glucose control in long-term CSII users. A reduction of HbA1c levels by -1.1% was maintained during the study period.
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Affiliation(s)
- Goran Petrovski
- Medical Faculty, Center for Insulin Pump and Sensor, University Clinic of Endocrinology , Diabetes and Metabolic Disorders, Skopje, Macedonia
| | - Marija Zivkovic
- Medical Faculty, Center for Insulin Pump and Sensor, University Clinic of Endocrinology , Diabetes and Metabolic Disorders, Skopje, Macedonia
| | - Slavica Subeska Stratrova
- Medical Faculty, Center for Insulin Pump and Sensor, University Clinic of Endocrinology , Diabetes and Metabolic Disorders, Skopje, Macedonia
| | - Biljana Jovanovska Todorova
- Medical Faculty, Center for Insulin Pump and Sensor, University Clinic of Endocrinology , Diabetes and Metabolic Disorders, Skopje, Macedonia
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23
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Abstract
Toddlers with type 1 diabetes have distinctive combination of challenges to their families and healthcare providers. A major factor is the difficulty in achieving metabolic control without risking hypoglycemia. The rising incidence of type 1 diabetes in toddlers increases the magnitude of the problem and creates a greater need for providing specialized service to cater for this age group's unique need. Type 1 has a specific disease nature in younger children and its clinical presentation mimics common childhood diseases. Symptoms and signs in the newly presented toddler with diabetes might be unspecific causing diagnosis to be missed or delayed. With the low cognitive ability and immature communication, toddlers might not be able to express their ill-feeling resulting from hypoglycemia or hyperglycemia. Hypoglycemia fear is common, which aggravates stress and reduces adherence to strict metabolic control. Nocturnal hypoglycemia is more common in toddlers and can be undiagnosed unless continuous glucose monitoring is used. Insulin administration and adjustment can be challenging due to pain, fear, refusal, and frequent intercurrent illness. Glucose monitoring is crucial. However, it can be distressing to the child and difficult to adhere to due to commitment or financial reasons. Insulin pump therapy is proven to be an effective and a safe method of treatment for toddlers, but it requires intensive training, resources, and long-term support. Provision of multidisciplinary team with special expertise in managing toddlers with diabetes is essential. Providing more physiological insulin regimes and customized technology is required to improve treatment compliance and diabetes control.
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Affiliation(s)
- Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital , Abu Dhabi, United Arab Emirates
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