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van den Boom L, Auzanneau M, Woelfle J, Sindichakis M, Herbst A, Meraner D, Hake K, Klinkert C, Gohlke B, Holl RW. Use of Continuous Glucose Monitoring in Pump Therapy Sensor Augmented Pump or Automated Insulin Delivery in Different Age Groups (0.5 to <26 Years) With Type 1 Diabetes From 2018 to 2021: Analysis of the German/Austrian/Swiss/Luxemburg Diabetes Prospective Follow-up Database Registry. J Diabetes Sci Technol 2024; 18:1122-1131. [PMID: 36840616 DOI: 10.1177/19322968231156601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
AIM Insulin pump, continuous glucose monitoring (CGM), and sensor augmented pump (SAP) technology have evolved continuously leading to the development of automated insulin delivery (AID) systems. Evaluation of the use of diabetes technologies in people with T1D from January 2018 to December 2021. METHODS A patient registry (Diabetes Prospective Follow-up Database [DPV]) was analyzed for use of SAP (insulin pump + CGM ≥90 days, no automated dose adjustment) and AID (HCL or LGS/PLGS). In total 46,043 people with T1D aged 0.5 to <26 years treated in 416 diabetes centers (Germany, Austria, Luxemburg, and Switzerland) were included and stratified into 4 groups A-D according to age. Additionally, TiR and HbA1c were analyzed. RESULTS From 2018 to 2021, there was a significant increase from 28.7% to 32.9% (sensor augmented pump [SAP]) and 3.5% to 16.6% (AID) across all age groups, with the most frequent use in group A (<7 years, 38.8%-40.2% and 10.3%-28.5%). A similar increase in SAP and AID use was observed in groups B (7 to <11 years) and C (11 to <16 years): B: +15.8 PP, C: +15.9 PP. HbA1c improved significantly in groups C and D (16 to <26 years) (both P < .01). Time in range (TiR) increased in all groups (A: +3 PP; B: +5 PP; C: +5 PP; D: +5 PP; P < 0.01 for each group). Insulin pumps (61.0% versus 53.4% male) and SAP (33.5% versus 28.9% male) are used more frequently in females. CONCLUSION In recent years, we found an increasing use of new diabetes technologies and an improvement in metabolic control (TiR) across all age groups.
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Affiliation(s)
- Louisa van den Boom
- Division of Pediatrics/Pediatric Diabetology, DRK Hospital, Kirchen, Germany
- Division of Pediatric Diabetology, Endocrinology, Metabolism and Obesity, Children's Hospital, University of Bonn, Bonn, Germany
| | - Marie Auzanneau
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Joachim Woelfle
- Children's and Adolescent's Hospital, University of Erlangen, Erlangen, Germany
| | | | - Antje Herbst
- Centre for Paediatrics, Medical Clinic Leverkusen, Leverkusen, Germany
| | - Dagmar Meraner
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Hake
- Children's Hospital, Müritzklinikum Waren, Waren, Germany
| | | | - Bettina Gohlke
- Division of Pediatric Diabetology, Endocrinology, Metabolism and Obesity, Children's Hospital, University of Bonn, Bonn, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
- German Center for Diabetes Research, Neuherberg, Germany
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Liarakos AL, Hasan N, Crabtree TSJ, Leelarathna L, Hammond P, Hussain S, Haq M, Aslam A, Gatdula E, Gibb FW, Lumb A, Bull K, Chinnasamy E, Carrieri G, Williams DM, Choudhary P, Ryder REJ, Wilmot EG. Real-world outcomes of Omnipod DASH system use in people with type 1 diabetes: Evidence from the Association of British Clinical Diabetologists (ABCD) study. Diabetes Res Clin Pract 2024; 209:111597. [PMID: 38417535 DOI: 10.1016/j.diabres.2024.111597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/01/2024]
Abstract
AIMS To evaluate real-world outcomes in people with Type 1 Diabetes (PwT1D) initiated on Omnipod DASH® Insulin Management System. METHODS Anonymized clinical data were submitted to a secure web-based tool within the National Health Service network. Hemoglobin A1c (HbA1c), sensor-derived glucometrics, total daily dose of insulin (TDD), and patient-reported outcome changes between baseline and follow-up were assessed. Individuals were classified to "new-to-pump" (switched from multiple daily injections) and "established-on-pump" (switched from a tethered insulin pump) groups. RESULTS 276 individuals from 11 centers [66.7 % female; 92 % White British; median age 41 years (IQR 20-50); diabetes duration 20 years (IQR 11-31); 49.3 % within "new-to-pump" group] were included. Baseline HbA1c was 8.0 ± 1.3 % (64 ± 14 mmol/mol). At follow-up [3 years (IQR 1.5-3.2)], HbA1c reduced by 0.3 % [(3 mmol/mol); p = 0.002] across the total population, 0.4 % [(5 mmol/mol); p = 0.001] in those "new-to-pump" and remained unchanged in those "established-on-pump". TDD decreased in the "new-to-pump" cohort (baseline:44.9 ± 21.0units vs follow-up:38.1 ± 15.4units, p = 0.002). Of those asked, 141/143 (98.6 %) stated Omnipod DASH had a positive impact on quality of life. CONCLUSIONS Omnipod DASH was associated with improvements in HbA1c in PwT1D "new-to-pump" and maintained previous HbA1c levels in those "established-on-pump". User satisfaction in all groups and TDD reduction in those "new-to-pump" were reported.
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Affiliation(s)
- Alexandros L Liarakos
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK; School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Nebras Hasan
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | - Thomas S J Crabtree
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK; School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Lalantha Leelarathna
- Diabetes, Endocrinology and Metabolism Center, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK
| | - Peter Hammond
- Department of Diabetes and Endocrinology, Harrogate and District NHS Trust, Harrogate, UK
| | - Sufyan Hussain
- Department of Diabetes and Endocrinology, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King's College London, London, UK
| | - Masud Haq
- Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Royal Tunbridge Wells, UK
| | - Aisha Aslam
- Diabetes, Endocrinology and Metabolism Center, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK
| | - Erneda Gatdula
- Cardiff and Vale University Health Board, University Hospital of Llandough, Llandough, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK; University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Alistair Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Kirsty Bull
- Stockport Foundation Trust, Stepping Hill Hospital, Stockport, UK
| | - Eswari Chinnasamy
- Kingston Hospital NHS Foundation Trust, Kingston Hospital, Surrey, UK
| | - Giorgio Carrieri
- Somerset NHS Foundation Trust, Musgrove Park Hospital, Taunton, UK
| | - David M Williams
- Swansea Bay University Health Board, Morriston Hospital, Swansea, UK
| | - Pratik Choudhary
- Leicester Diabetes Center, University Hospitals of Leicester, Leicester, UK; Diabetes Research Center, College of Health Sciences, University of Leicester, Leicester, UK
| | - Robert E J Ryder
- Department of Diabetes and Endocrinology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Emma G Wilmot
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK; School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
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Gandhi K, Ebekozien O, Noor N, McDonough RJ, Hsieh S, Miyazaki B, Dei-Tutu S, Golden L, Desimone M, Hardison H, Rompicherla S, Akturk HK, Kamboj MK. Insulin Pump Utilization in 2017-2021 for More Than 22,000 Children and Adults With Type 1 Diabetes: A Multicenter Observational Study. Clin Diabetes 2023; 42:56-64. [PMID: 38230341 PMCID: PMC10788665 DOI: 10.2337/cd23-0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
This large type 1 diabetes cohort study showed that insulin pump utilization has increased over time and that use differs by sex, insurance type, and race/ethnicity. Insulin pump use was associated with more optimal A1C, increased use of continuous glucose monitoring (CGM), and lower rates of diabetic ketoacidosis and severe hypoglycemia. People who used an insulin pump with CGM had lower rates of acute events than their counterparts who used an insulin pump without CGM. These findings highlight the need to improve access of diabetes technology through provider engagement, multidisciplinary approaches, and efforts to address health inequities.
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Affiliation(s)
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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Aleppo G, DeSalvo DJ, Lauand F, Huyett LM, Chang A, Vienneau T, Ly TT. Improvements in Glycemic Outcomes in 4738 Children, Adolescents, and Adults with Type 1 Diabetes Initiating a Tubeless Insulin Management System. Diabetes Ther 2023; 14:593-610. [PMID: 36763329 PMCID: PMC9913031 DOI: 10.1007/s13300-023-01366-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Despite recent advances in diabetes technology, most people living with type 1 diabetes mellitus (T1D) are unable to meet glycemic targets. Real-world evidence can provide insight into outcomes achieved with specific treatment devices when used in clinical practice. The aim of this study was to analyze real-world outcomes collected from a large cohort of people living with T1D and initiating treatment with the Omnipod DASH System. METHODS In this retrospective observational study, real-world outcomes were analyzed from a database of information collected from people with T1D initiating the Omnipod DASH System. Information in the database was either taken directly from the patient's medical record or self-reported if medical records were unavailable. The primary outcome was change in glycated hemoglobin (HbA1c) from baseline (before initiation) to 3 months after initiation. Secondary outcomes were changes in total daily dose of insulin (TDD) and self-reported frequency of hypoglycemic events (< 70 mg/dL). Results are separated for the adult (≥ 18 years, N = 3341) and pediatric (< 18 years, N = 1397) cohorts. RESULTS The change in HbA1c from baseline was - 0.9 ± 1.6% ( - 10 ± 18 mmol/mol; p < 0.0001) in adults and - 0.9 ± 2.0% ( - 10 ± 22 mmol/mol; p < 0.0001) in the pediatric cohort. For those previously using multiple daily injections, HbA1c decreased by - 1.0 ± 1.7% ( - 11 ± 19 mmol/mol) in adults and - 1.0 ± 2.1% ( - 11 ± 23 mmol/mol) in the pediatric cohort (both p < 0.0001). Hypoglycemic events decreased in adults from 2.9 to 1.3 episodes per week ( - 1.6 ± 3.2 events/week; p < 0.0001), and in the pediatric cohort from 2.8 to 1.5 episodes per week ( - 1.3 ± 2.7 events/week; p < 0.0001). In adults, TDD decreased by 19.9% (p < 0.0001), and it remained stable in the pediatric cohort (p > 0.05). CONCLUSIONS Real-world outcomes from this large cohort of people initiating therapy with the Omnipod DASH System showed significant improvement in HbA1c and a substantial reduction in hypoglycemic events after 3 months of use.
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Affiliation(s)
- Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, 645 North Michigan Ave, Suite 530, Chicago, IL, 60611, USA
| | - Daniel J DeSalvo
- Baylor College of Medicine, 1 Moursund St., Houston, TX, 77030, USA
| | - Felipe Lauand
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
| | | | - Albert Chang
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
| | - Todd Vienneau
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
| | - Trang T Ly
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
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Nivet E, Lo G, Nivot-Adamiak S, Guitteny MA, De Kerdanet M. Impact of OMNIPOD® on the quality of life of adolescents with type 1 diabetes. Arch Pediatr 2021; 29:21-26. [PMID: 34753634 DOI: 10.1016/j.arcped.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/28/2021] [Accepted: 10/03/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Several pediatric studies have demonstrated that therapy using a conventional insulin pump improves glycemic control and quality of life. At the beginning of this study, a new tubeless insulin pump, Omnipod®, had recently been marketed in France. OBJECTIVES Analyze the response of adolescents treated with multiple injections to the proposal to use this new medical device and compare both the quality of life and the glycemic control of adolescents according to their choice. MATERIAL AND METHODS This was a prospective, observational study of adolescents aged 10-17 years who had type 1 diabetes for more than 1 year, all treated with multi-injection insulin delivery according to a basal-bolus regimen. They were separated into three groups: group A choosing to use the Omnipod® system, group B taking the time to think before making a decision, and group C choosing to keep their multi-injection therapy. The three groups were compared according to their quality of life with validated tools and glycemic control. RESULTS Groups were formed with 30 (25%) patients in group A, 55 patients (45%) in group B, and 36 patients (30%) in group C. As to the WHO Well-Being Index, no significant difference appeared in the study for the patients in the three groups. An increased treatment satisfaction score was found, evolving from 3.79 ± 0.68 to 4.36 ± 0.56, p = 0.002 (group A) and from 3.87 ± 0.7 to 4.16 ± 0.7, p = 0.032 (group B), with no significant change for group C (from 4.39 ± 0.6 to 4.31 ± 0.62, p = 0.582). The wish to change treatment score improved for group A (from 4.14 ± 0.88 to 1.68 ± 0.9; p < 0.001) and group B (from 3.51 ± 1.05 to 1.84 ± 1; p < 0.001), with no significant change for group C (from 1.81 ± 0 0.98 to 1.61 ± 0.8; p = 0.432). There was no significant difference regarding HbA1c rates in the three groups. CONCLUSION There was no significant difference in quality-of-life scores between adolescents who chose to switch from multiple injection to the tubeless patch pump and those who retained multi-injection treatment, but increased satisfaction was observed in the former group.
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Affiliation(s)
- E Nivet
- Service endocrinologie pédiatrique, Assistante spécialiste, CHU Rennes, Hôpital Sud, 16 boulevard de Bulgarie, 35200 Rennes, France.
| | - G Lo
- PH endocrinologue et diabétologue pédiatrique, CH Libourne,70 Rue Réaux, 33500 Libourne, France
| | - S Nivot-Adamiak
- Service endocrinologie pédiatrique, PH endocrinologue et diabétologue pédiatrique, CHU Rennes, Hôpital Sud, 16 boulevard de Bulgarie, 35200 Rennes, France
| | - M-A Guitteny
- Service endocrinologie pédiatrique, PH endocrinologue et diabétologue pédiatrique, CHU Rennes, Hôpital Sud, 16 boulevard de Bulgarie, 35200 Rennes, France
| | - M De Kerdanet
- Service endocrinologie pédiatrique, PH endocrinologue et diabétologue pédiatrique, CHU Rennes, Hôpital Sud, 16 boulevard de Bulgarie, 35200 Rennes, France
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Biester T, Schwandt A, Heidtmann B, Rami-Merhar B, Haak T, Festa A, Kostow S, Müller A, Mönkemöller K, Danne T. Declining Frequency of Acute Complications Associated with Tubeless Insulin Pump Use: Data from 2,911 Patients in the German/Austrian Diabetes Patienten Verlaufsdokumentation Registry. Diabetes Technol Ther 2021; 23:527-536. [PMID: 33684335 PMCID: PMC8377506 DOI: 10.1089/dia.2020.0675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: To characterize patients with diabetes treated with a tubeless insulin pump (Omnipod® Insulin Management System; Insulet Corp., Acton, MA), and to evaluate the frequency of acute complications with long-term use of the system. Methods: This retrospective analysis of the German/Austrian Diabetes Patienten Verlaufsdokumentation (DPV) registry included data from 3657 patients with diabetes (n = 3582 type 1, n = 25 type 2, n = 50 latent autoimmune diabetes in adults/other) treated with a tubeless insulin pump. Hemoglobin A1c (HbA1c) levels and frequency of diabetic ketoacidosis (DKA) and severe hypoglycemia (SH) were compared between 1 year pre- and 1 year (n = 2911) or up to 3 years (n = 1311) post-tubeless insulin pump initiation and compared with a contemporary cohort on multiple daily injections (MDI) with 3-year data (n = 1874). Results: Patients using tubeless insulin pump therapy had a median age of 13.7 years [interquartile range 10.8, 17.3], diabetes duration 3.7 years [1.7, 8.0], and HbA1c 7.5% [6.9, 8.2]. In patients with 3 years of follow-up data (n = 1311), the percentage with ≥1 episode of DKA, SH (Level 3, requiring assistance), and SH (coma) event with prior treatment was 6.3%, 5.5%, and 1.7%, respectively. After 3 years of tubeless insulin pump therapy, the frequency of DKA, SH (Level 3), and SH (coma) decreased to 2.2%, 4.1%, and 0.5%, respectively. Both DKA and SH remained significantly lower compared with MDI after adjustment in multiple regression analysis. High treatment retention rates (>90%) were observed. Conclusion: Real-world registry data document that tubeless insulin pump therapy is associated with good glycemic control and a low frequency of DKA and SH in an age group prone to acute complications.
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Affiliation(s)
- Torben Biester
- AUF DER BULT Diabetes Center for Children and Adolescents, Hannover, Germany
| | - Anke Schwandt
- Institute for Epidemiology and Medical Biometry,ZIBMT,Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD),Neuherberg, Germany
| | | | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine,Medical University of Vienna, Vienna, Austria
| | - Thomas Haak
- Diabetes Clinic Bad Mergentheim,Bad Mergentheim,Germany
| | - Andreas Festa
- Landesklinikum Korneuburg Stockerau,Korneuburg Stockerau,Austria
| | - Susanne Kostow
- Sana Klinikum Lichtenberg—Oskar-Ziethen-Krankenhaus,Berlin,Germany
| | | | | | - Thomas Danne
- AUF DER BULT Diabetes Center for Children and Adolescents, Hannover, Germany
- Address correspondence to: Thomas Danne, MD, Diabetes Center for Children and Adolescents, Kinder-und Jugendkrankenhaus AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
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7
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Brown RE, Vienneau T, Aronson R. Canadian Real-World Outcomes of Omnipod Initiation in People with Type 1 Diabetes (COPPER study): Evidence from the LMC Diabetes Registry. Diabet Med 2021; 38:e14420. [PMID: 33040383 PMCID: PMC8246772 DOI: 10.1111/dme.14420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022]
Abstract
AIMS To investigate real-world clinical outcomes in adults with type 1 diabetes who initiated the Omnipod Insulin Management System (Insulet Corp., Acton, MA, USA) compared to a matched cohort who maintained multiple daily injection therapy. METHODS This retrospective observational study used data from the Canadian LMC Diabetes Registry. Adults with type 1 diabetes who switched from multiple daily injections to the Omnipod system as usual standard of care between January 2011 and April 2019 were matched to a cohort of adults with type 1 diabetes who maintained multiple daily injection therapy, using propensity-score matching. The primary outcome was change in HbA1c at 3- to 6-month follow-up. RESULTS Propensity-score matching resulted in a final analytical cohort of 286 individuals (143/cohort). HbA1c in the Omnipod cohort was reduced by a mean ± sd of -3 ± 10 mmol/mol (-0.2 ± 1.0%; P = 0.005) with no change in the MDI cohort [0 ± 10 mmol/mol (0.0 ± 1.0%); P = 0.74]. HbA1c change was seen only in persons with baseline HbA1c ≥75 mmol/mol (≥9.0%) [Omnipod cohort: -15 ± 12 mmol/mol (-1.4 ± 1.1%); P < 0.001] with a between-treatment difference [mean (95% CI)] of -12 (-18, -6) mmol/mol [-1.1 (-1.6, -0.5) %, P < 0.001]. The median total daily dose of insulin was lower following Omnipod initiation (baseline 0.63 U/kg vs follow-up 0.53 U/kg; P < 0.001), with no change in the MDI cohort (baseline 0.68 U/kg vs follow-up 0.67 U/kg; P = 0.23). CONCLUSIONS Adults with type 1 diabetes who initiated use of the Omnipod system in a real-world clinical setting had lower HbA1c and total daily dose of insulin at 3- to 6-month follow-up compared to a matched cohort of adults who maintained multiple daily injection therapy. A treatment difference in HbA1c change was seen only in people with baseline HbA1c ≥ 75 mmol/mol (9.0%). (Clinical trials registration: NCT04226378).
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Affiliation(s)
- R. E. Brown
- LMC Diabetes and EndocrinologyTorontoONCanada
| | | | - R. Aronson
- LMC Diabetes and EndocrinologyTorontoONCanada
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Carlson AL, Huyett LM, Jantz J, Chang A, Vienneau T, Ly TT. Improved glycemic control in 3,592 adults with type 2 diabetes mellitus initiating a tubeless insulin management system. Diabetes Res Clin Pract 2021; 174:108735. [PMID: 33711396 DOI: 10.1016/j.diabres.2021.108735] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/22/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
AIMS To compare glycemic outcomes in adults with type 2 diabetes mellitus (T2DM) before and 90 days after initiating Omnipod® or Omnipod DASH® Insulin Management Systems. METHODS In this retrospective observational study (N = 3,592) change in HbA1c level, total daily dose (TDD) of insulin (n = 3,053), and frequency of self-reported hypoglycemic events (HE, <70 mg/dL, n = 2,922) were assessed overall and by prior treatment modality (multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII)), age group, and baseline HbA1c category. RESULTS Change (mean ± SD) in HbA1c was -1.3 ± 1.7% [-14 ± 19 mmol/mol] overall, -1.4 ± 1.7% [-15 ± 19 mmol/mol] for prior MDI users, and -0.9 ± 1.5% [-10 ± 16 mmol/mol] for prior CSII users (p<0.0001). The percentage of patients with HbA1c ≥9% [≥75 mmol/mol] decreased (49% to 19%), and with HbA1c <7% [<53 mmol/mol] increased (10% to 22%) (p<0.0001). Prior therapy, age, and baseline HbA1c category were factors affecting change in HbA1c (p<0.05). Reductions in TDD (overall, -33 ± 52U, p<0.0001) and HE per week (overall, -0.5 ± 2.0, p<0.0001), were seen regardless of prior treatment, age, or baseline HbA1c. CONCLUSIONS Omnipod System use was associated with statistically and clinically meaningful reductions in HbA1c, TDD, and HE compared to prior treatments in T2DM.
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Affiliation(s)
- Anders L Carlson
- International Diabetes Center at Park Nicollet, 3800 Park Nicollet Blvd, Minneapolis, MN 55416, United States
| | - Lauren M Huyett
- Insulet Corporation, 100 Nagog Park, Acton, MA 01720, United States
| | - Jay Jantz
- Insulet Corporation, 100 Nagog Park, Acton, MA 01720, United States
| | - Albert Chang
- Insulet Corporation, 100 Nagog Park, Acton, MA 01720, United States
| | - Todd Vienneau
- Insulet Corporation, 100 Nagog Park, Acton, MA 01720, United States
| | - Trang T Ly
- Insulet Corporation, 100 Nagog Park, Acton, MA 01720, United States.
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9
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Biester T, Grimsmann JM, Heidtmann B, Rami-Merhar B, Ermer U, Wolf J, Freff M, Karges B, Agena D, Bramlage P, Danne T, Holl RW. Intermittently Scanned Glucose Values for Continuous Monitoring: Cross-Sectional Analysis of Glycemic Control and Hypoglycemia in 1809 Children and Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2021; 23:160-167. [PMID: 33084351 DOI: 10.1089/dia.2020.0373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and Objective: Intermittent scanning continuous glucose monitoring (iscCGM) is increasingly used for glycemic monitoring in diabetes care. In this cross-sectional real-world analysis, iscCGM data were compared to traditional parameters of glycemic control in young people with type 1 diabetes. Methods: Using the DPV registry, most recent data from children and adolescents aged <18 years with uploaded iscCGM sensor profiles with at least 14 days of data and a > 50% completeness were evaluated using recommended parameters of sensor metrics. Analysis was performed stratified by age group, glycemic control, and type of therapy; data were taken from DPV data pool in February 2020. Results: Glucose sensor profiles and clinical data from 1809 individuals (mean age 13.4 years, 53% male, and mean diabetes duration 5.02 years) were evaluated in this study. More than 50% of this population (n = 965) reached the current German treatment target of hemoglobin A1c (HbA1c) <7.5%. In this target, the mean scanning frequency was higher than in groups with HbA1c >7.5 or >8.0% (12.0 vs. 10.2 vs 7.6 times per day). The group of preschool children had the highest frequency of scanning (16.6 vs. 13.3 times per day in school kids and 7.9 in adolescents), the lowest HbA1c level, and the lowest risk for hypoglycemia (low blood glucose index 0.8 vs. 1.0 vs 1.2). Conclusion: Real-world data will help to determine the value of iscCGM to improve clinical and patient-related outcomes in pediatric diabetology. Not only the use of a device but also the intensity of use seems to have a high and direct impact on glycemic control.
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Affiliation(s)
- Torben Biester
- Kinder-und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Julia M Grimsmann
- Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | | | - Birgit Rami-Merhar
- Medical University of Vienna, Austria, Department od Pediatric and Adolescent Medicine, Vienna, Austria
| | - Uwe Ermer
- Kliniken St. Elisabeth, Klinik für Kinder-und Jugendmedizin, Neuburg, Germany
| | - Johannes Wolf
- Klinik für Kinder-und Jugendmedizin St. Louise, St. Vincenz-Krankenhaus, Paderborn, Germany
| | - Markus Freff
- Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany
| | - Beate Karges
- Bethlehem Gesundheitszentrum, Klinik für Kinder-und Jugendmedizin, Stolberg, Germany
- Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
| | - Dirk Agena
- Kinderärztliche Gemeinschaftspraxis Franziska Fritz und Dirk Agena, Hildesheim, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Thomas Danne
- Kinder-und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Reinhard W Holl
- Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
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10
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Berlanda G, Telo GH, Krug BC, Scheffel RS, Pasinato B, Iorra F, Dos Reis JG, Picon PD, Schaan BD. Hypoglycemia frequency and treatment satisfaction in patients receiving insulin analogues for treatment of type 1 diabetes mellitus. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:164-171. [PMID: 33905628 DOI: 10.20945/2359-3997000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to evaluate the frequency of hypoglycemia and the treatment satisfaction in patients with type 1 diabetes (T1D) using insulin analogues. Methods This observational retrospective study included 516 adult patients with T1D from 38 cities in Southern Brazil. Demographics and clinical data were collected using a self-report questionnaire. Hypoglycemia was defined as an event based on either symptoms or self-monitored blood glucose < 70 mg/dL. Treatment satisfaction was evaluated using the Diabetes Treatment Satisfaction Questionnaire status version (DTSQs) and with a specific question with scores ranging from 0-10. Common mental disorders were assessed using the General Health Questionnaire (GHQ-12). Results Overall, the mean age was 38 ± 14 years and 52% of the participants were women. The median diabetes duration was 18 years. The scores for insulin analogue treatment satisfaction were higher than those for previous treatments. DTSQ scores had a median value of 32 (interquartile range 29-35) and remained unchanged over time. The percentage of patients with hypoglycemia (including severe and nocturnal) was comparable across groups divided according to duration of use of insulin analogues. Most patients (n=395, 77%) screened positive for common mental disorders. Conclusion Patient satisfaction with insulin analogue treatment was high and remained unchanged with time. Episodes of hypoglycemia also remained unchanged over time among patients using insulin analogues.
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Affiliation(s)
- Gabriela Berlanda
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil,
| | - Gabriela H Telo
- Departamento de Medicina Interna, Escola de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Rafael Selbach Scheffel
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Bruna Pasinato
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Fernando Iorra
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - João Gabbardo Dos Reis
- Coordenação Executiva do Comitê de Contingência de Combate ao COVID-19 do Governo do Estado de São Paulo, SP, Brasil
| | - Paulo Dornelles Picon
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil.,Secretaria Estadual da Saúde do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Beatriz D Schaan
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
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11
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Mehta SN, Tinsley LJ, Kruger D, Bode B, Layne JE, Huyett LM, Dryga K, Dumais B, Ly TT, Laffel LM. Improved Glycemic Control Following Transition to Tubeless Insulin Pump Therapy in Adults With Type 1 Diabetes. Clin Diabetes 2021; 39:72-79. [PMID: 33551556 PMCID: PMC7839599 DOI: 10.2337/cd20-0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Continuous subcutaneous insulin infusion (CSII) treatment may improve long-term glycemic outcomes and enhance quality of life compared with a multiple daily injection (MDI) insulin regimen for people with type 1 diabetes. As the number of people treated with CSII via a tubeless insulin pump is increasing, there is growing interest in the long-term glycemic outcomes of this treatment option across diverse populations. This multicenter, retrospective study evaluated glycemic control in 156 adults with type 1 diabetes initiating tubeless insulin pump therapy following transition from either MDI or CSII with a tubed insulin pump. In this study, use of the tubeless insulin pump over 12 months was associated with significant improvement in A1C in adults with type 1 diabetes, most notably in those with an A1C ≥9.0% and those previously treated with MDI.
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Affiliation(s)
| | | | | | - Bruce Bode
- Atlanta Diabetes Associates, Atlanta, GA
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12
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Wang X, Zhao X, Chen D, Zhang M, Gu W. Comparison of Continuous Subcutaneous Insulin Infusion and Multiple Daily Injections in Pediatric Type 1 Diabetes: A Meta-Analysis and Prospective Cohort Study. Front Endocrinol (Lausanne) 2021; 12:608232. [PMID: 33737909 PMCID: PMC7961074 DOI: 10.3389/fendo.2021.608232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/21/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The incidence of pediatric type 1 diabetes (T1D) is increasing worldwide, and the appropriate choice of therapy regimens is important for children, especially in developing countries with inadequate resources. METHODS We conducted a design combining meta-analysis and prospective cohort study. In meta-analysis, 14 studies involving 69,085 TID cases reported glycosylated hemoglobin (HbA1c) levels, including 48,363 multiple daily insulin injections therapy (MIT) and 20,722 continuous subcutaneous insulin infusion (CSII). In our prospective cohort study, TID cases were recruited from a tertiary children's hospital, and randomly divided into Group MIT and Group CSII. After the 4-year follow-up, the effects of MDI (n = 112) and CSII (n = 76) therapy on glycemic control, long-term complications, as well as the growth and pubertal development were explored. RESULTS Compared to CSII in TID, HbA1c levels in MDI (WMD = 0.21, 95% CI: 0.20 to 0.23) were increased significantly in meta-analysis. Among 188 clinical cases, mean age at recruitment was 7.55 (SD 2.91) years. Duration of TID was 4.23 (SD 2.61) years. 50.53% (n = 95) of them were boys. The 4-year follow-up showed that children's HbA1c was 0.67 (95% CI -1.28, -0.05) % lower in children with CSII compared to children with MDI in multivariable regression models with adjustment for potential confounders (children's age at follow-up, duration of TID, gender, birthweight, parity, and delivery method). CSII was associated with 2.31 kg higher in children's weight (95% CI 0.59, 4.04) in the adjusted model. No difference was found in peripheral nerve and fundus consequences as well as the status of obesity and thin and pubertal development between CSII and MIT. CONCLUSION CSII might be associated with better glycemic control and better effect for children growth development. No higher risks of long-term complications and delayed pubertal development were observed in CSII. Our findings provided evidence for a better therapy regimen for T1D in children, nevertheless, they need to be validated by a larger sample size study.
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Affiliation(s)
- Xu Wang
- Department of Endocrinology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Xue Zhao
- Department of Endocrinology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Danrong Chen
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mingzhi Zhang
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Wei Gu
- Department of Endocrinology, Children’s Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Wei Gu,
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13
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Abstract
BACKGROUND Advances in pump technology have increased the popularity of this treatment modality among patients with type 1 diabetes and recently also among patients with type 2 diabetes. AREAS OF UNCERTAINTY Four decades after the incorporation of the insulin pump in clinical use, questions regarding its efficacy, occurrence rate of short-term complications as hypoglycemia and diabetes ketoacidosis, timing of pump initiation, and selected populations for use remain unanswered. DATA SOURCES A review of the literature was performed using the PubMed database to identify all articles published up till December 2018, with the search terms including insulin pump therapy/continuous subcutaneous insulin delivery. The Cochrane database was searched for meta-analysis evaluating controlled randomized trials. Consensuses guidelines published by the International Society for Pediatric and Adolescent Diabetes, American Diabetes Association, and Advanced Technologies and Treatments for Diabetes year books were additionally reviewed for relevant cited articles. THERAPEUTIC ADVANCES Insulin pump therapy offers flexible management of diabetes. It enables adjustment of basal insulin to daily requirements and circadian needs, offers more precise treatment for meals and physical activity, and, when integrated with continuous glucose monitoring, allows glucose responsive insulin delivery. The ability to download and transmit data for analysis allow for treatment optimization. Newer pumps are simple to operate and increase user experience. Studies support the efficacy of pump therapy in improving glycemic control and reducing the occurrence of hypoglycemia without increasing episodes of diabetes ketoacidosis. They also improve quality of life. Recent evidence suggests a role for pump therapy in reducing microvascular and macrovascular diabetes-related complications. CONCLUSIONS Insulin pump therapy appears to be effective and safe in people with T1D regardless of age. Future advancements will include incorporation of closed loop and various decision support systems to aid and improve metabolic control and quality of life.
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14
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Merzon E, Grossman J, Vinker S, Merhasin I, Levit S, Golan-Cohen A. Factors associated with withdrawal from insulin pump therapy: A large-population-based study. Diabetes Metab Res Rev 2020; 36:e3288. [PMID: 31922314 DOI: 10.1002/dmrr.3288] [Citation(s) in RCA: 7] [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] [Received: 05/13/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although, number of diabetic patients received insulin pump (IP) therapy is increasing; there are limited data regarding factors associated with IP withdrawal. METHODS We conducted a cross-sectional study using data from an Israeli health maintenance organization. All patients, 21 or older, with type 1 (T1DM) or type 2 (T2DM) diabetes, who received IP therapy for a 7-year period were identified. Patients who did not purchase IP maintenance supplies for at least six consecutive months were defined as withdrawn (N = 355). Patients who purchased supplies were defined as adherent (N = 352). RESULTS In both T1DM and T2DM patients, withdrawal from IP therapy was positively associated with duration of diabetes longer than 5 years (odds ratio [OR] = 13.26 [CI, 7.16-23.34; P < .001] and OR = 10.92 [CI, 5.64-21.14; P < .001], respectively), nonadherence to dietician follow-up (OR = 5.78 [CI, 3.65-9.14; P < .001] and OR = 3.41 [CI, 1.99-5.85; P < .001], respectively), and poor glycaemic control prior to IP treatment (OR = 4.04 [CI, 2.18-7.48; P < .001] and OR = 4.59 [CI, 2.71-7.81; P < .001], respectively]. Co-morbid neuro-psychiatric disorders were also risk factors for IP withdrawal: diagnosis of depression (OR = 2.22 [CI, 1.16-4.27; P = .017] and Attention Deficit Hyperactivity Disorder (ADHD) OR = 2.45 [CI, 1.003-5.087; P = .043]) among T1DM patients; and diagnosis of depression (OR = 1.85 [CI, 1.05-5.27; P = .046] and dementia OR = 4.03 [CI, 1.03-19.77; P = .048]) among T2DM patients. CONCLUSION In our large real-world population-based study, we found that smoking, obesity, poor glycaemic control, and co-morbid neuro-psychiatric disorders were associated with a high rate of withdrawal from IP therapy. Health care providers ought to familiarize themselves with patient characteristics predictive of nonadherence and should intensify patient follow-up when incorporating this new, costly, and challenging technology.
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Affiliation(s)
- Eugene Merzon
- Medical Division, Leumit HMO, Tel-Aviv, Israel
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeremy Grossman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Vinker
- Medical Division, Leumit HMO, Tel-Aviv, Israel
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilia Merhasin
- Central District Headquarter, Leumit HMO, Netanya, Israel
| | - Shmuel Levit
- Diabetes Institute, Assuta Medical Center, Tel Aviv, Israel
| | - Avivit Golan-Cohen
- Medical Division, Leumit HMO, Tel-Aviv, Israel
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Brorsson AL, Leksell J, Andersson Franko M, Lindholm Olinder A. A person-centered education for adolescents with type 1 diabetes-A randomized controlled trial. Pediatr Diabetes 2019; 20:986-996. [PMID: 31268224 DOI: 10.1111/pedi.12888] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/18/2019] [Accepted: 06/21/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Young people with type 1 diabetes and their parents need to receive person-centered education to be able to manage their diabetes. Guided Self-Determination-Young (GSD-Y) is a person-centered communication and reflection education model that can be used in educational program for young people with type 1 diabetes. OBJECTIVE To evaluate whether GSD-Y leads to improved glycaemic control, increased self-perceived health and health-related quality of life, fewer diabetes-related family conflicts, and improved self-efficacy in a group-based intervention for adolescents starting continuous subcutaneous insulin infusion (CSII) and their parents. METHODS This randomized controlled trial included 71 adolescents starting CSII. Participants were followed for 12 months. The intervention group (n = 37) attended seven group training sessions over a period of 5 months, using the GSD-Y model, the control group received standard care. Variables evaluated were HbA1c, self-perceived health, health-related quality of life, family conflicts, self-efficacy, and usage of continuous glucose monitoring. RESULTS When adjusted for sex and family conflicts, there was a difference in glycaemic control between the groups at 12 months, favoring the intervention group (62 vs 70 mmol/mol, P = .009). When analyses were performed on boys and girls separately and adjusted for family conflicts, the only difference detected was for boys after 12 months (P = .019). The intervention showed no effect on self-perceived health, health-related related quality of life, family conflicts, or self-efficacy. CONCLUSIONS An intervention with GSD-Y may have an effect on glycaemic control. The content of the GSD-Y groups may serve as a model for person-centered care in adolescents with type 1 diabetes.
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Affiliation(s)
- Anna Lena Brorsson
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Janeth Leksell
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Mikael Andersson Franko
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Anna Lindholm Olinder
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
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16
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Markakis K, Alam T, Jinadev P, Chapman A, Urwin A, Thabit H, Boulton AJM, Rutter MK, Leelarathna L. Continuous Subcutaneous Insulin Infusion Initiation Is Associated With Blood Pressure Reduction in Adults With Type 1 Diabetes. J Diabetes Sci Technol 2019; 13:691-697. [PMID: 30636544 PMCID: PMC6610598 DOI: 10.1177/1932296818822818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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 In type 1 diabetes (T1D) continuous subcutaneous insulin infusion (CSII) use has been associated with lower risks for mortality and diabetes-related complications when compared to multiple daily injections. There are limited data on the effect of CSII on blood pressure (BP). We aimed to evaluate the relationship between CSII initiation and BP changes. METHODS We performed a retrospective, single-center, observational study including all adults with T1D who initiated CSII between 2001 and 2014. Mean systolic BP levels were calculated from values obtained up to 15 months before and up 15 months after CSII initiation. RESULTS We studied 436 adults (46% male; mean [95% CI] age: 45 [36, 54] years, duration of diabetes: 20.3 [19.1, 21.5] years). CSII was associated with the following changes (post minus pre CSII levels) in mean (95% CI) SBP and DBP levels, respectively: whole cohort (N = 436): -2 (-1, -3), P < .001 and -2 (-1, -2), P < .001; those taking stable antihypertensive medication (n = 118): -4 (-6, -2), P < .001 and -2 (-3, -1), P < .001; antihypertensive treatment-naïve patients (n = 279): -1 (-2, 0), P = .147 and -1 (-2, 0), P = .002. In multivariate regression analysis including age, sex, diabetes duration, pre-CSII BP, HbA1c and weight changes, only pre-CSII BP showed an independent association with BP drop in all patients' groups. Once adjusted for pre-CSII BP there was no significant difference between those on antihypertensive drugs and antihypertensive treatment-naïve individuals. CONCLUSIONS We showed BP reduction in association with CSII therapy particularly in those on antihypertensive medication. These original findings may partly explain the cardiovascular and mortality benefits associated with CSII therapy.
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Affiliation(s)
- Konstantinos Markakis
- Manchester Diabetes Centre, Manchester
University NHS Foundation Trust, Manchester Academic Health Science Centre,
Manchester, UK
| | - Tayiba Alam
- School of Medical Sciences, University
of Manchester, Manchester, UK
| | - Pushpa Jinadev
- Manchester Diabetes Centre, Manchester
University NHS Foundation Trust, Manchester Academic Health Science Centre,
Manchester, UK
| | - Alyson Chapman
- Manchester Diabetes Centre, Manchester
University NHS Foundation Trust, Manchester Academic Health Science Centre,
Manchester, UK
| | - Andrea Urwin
- Manchester Diabetes Centre, Manchester
University NHS Foundation Trust, Manchester Academic Health Science Centre,
Manchester, UK
| | - Hood Thabit
- Manchester Diabetes Centre, Manchester
University NHS Foundation Trust, Manchester Academic Health Science Centre,
Manchester, UK
- School of Medical Sciences, University
of Manchester, Manchester, UK
| | - Andrew J. M. Boulton
- Manchester Diabetes Centre, Manchester
University NHS Foundation Trust, Manchester Academic Health Science Centre,
Manchester, UK
- Division of Diabetes, Endocrinology and
Gastroenterology, University of Manchester, Manchester, UK
| | - Martin K. Rutter
- Manchester Diabetes Centre, Manchester
University NHS Foundation Trust, Manchester Academic Health Science Centre,
Manchester, UK
- Division of Diabetes, Endocrinology and
Gastroenterology, University of Manchester, Manchester, UK
| | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester
University NHS Foundation Trust, Manchester Academic Health Science Centre,
Manchester, UK
- Division of Diabetes, Endocrinology and
Gastroenterology, University of Manchester, Manchester, UK
- Lalantha Leelarathna, PhD, Manchester
Diabetes Centre, Hathersage Rd, Manchester, M13 9WL, UK.
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17
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Ly TT, Layne JE, Huyett LM, Nazzaro D, O’Connor JB. Novel Bluetooth-Enabled Tubeless Insulin Pump: Innovating Pump Therapy for Patients in the Digital Age. J Diabetes Sci Technol 2019; 13:20-26. [PMID: 30239214 PMCID: PMC6313290 DOI: 10.1177/1932296818798836] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The Omnipod DASH™ Insulin Management System (Insulet Corp, Billerica, MA) is a discreet, tubeless, wearable insulin pump that holds up to 200 units of U-100 insulin and delivers therapy through customizable basal rates and bolus amounts. This recently FDA-cleared system consists of the insulin pump ("Pod"), which is worn on body and delivers insulin, and the Personal Diabetes Manager (PDM), which is a handheld device used to wirelessly control and monitor the Pod functionality. The PDM can also be paired with the CONTOUR® NEXT ONE blood glucose (BG) meter (Ascensia Diabetes Care, Basel, Switzerland) to wirelessly receive BG readings. This review provides a detailed description of the Pod and PDM. Key features of the Pod are described, including the novel pump delivery mechanism, waterproof (IP28) housing design, and automated cannula insertion. The technology introduced in the new system, such as touchscreen PDM interface, Bluetooth® wireless technology, and wireless internet connectivity, is also presented. Last, Omnipod® Insulin Management System clinical data are reviewed, including early feasibility results for the Omnipod Horizon™ Automated Glucose Control hybrid closed-loop system.
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Affiliation(s)
- Trang T. Ly
- Insulet Corporation, Billerica, MA, USA
- Trang T. Ly, MBBS, FRACP, PhD, Insulet Corporation, 600 Technology Park Dr, Billerica, MA 01821, USA.
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18
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Burckhardt MA, Smith GJ, Cooper MN, Jones TW, Davis EA. Real-world outcomes of insulin pump compared to injection therapy in a population-based sample of children with type 1 diabetes. Pediatr Diabetes 2018; 19:1459-1466. [PMID: 30129154 DOI: 10.1111/pedi.12754] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/18/2018] [Accepted: 07/26/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Long-term glycemic outcomes in people with type 1 diabetes (T1D) on insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) with appropriate control data are limited. Randomized controlled studies of technology in diabetes care are generally limited in duration and likely to have a selection bias. Hence, evaluation of population-based data provides a robust alternative evaluation of the benefits of insulin pump therapy. AIM To investigate the outcomes of insulin pump therapy, as compared to injection therapy, in children with T1D attending a state-wide diabetes service in Western Australia. METHODS Patients using insulin pump therapy between January 1999 and July 2016 were matched to patients on injection therapy on the basis of age, date of diagnosis, and hemoglobin A1C (HbA1c) at the start of pump therapy. RESULTS A total of 513 pump-injection matches were identified. The pump cohort had a significantly lower mean HbA1c for the first 6 years of follow-up. The difference in HbA1c between the cohorts was observed by 6 months (3 mmol/mol [0.3%], standard error of the mean (SEM) 0.05, N = 463 matched pairs, P < 0.001) and was sustained with the greatest difference in HbA1c at 6 years (4 mmol/mol [0.4%], SEM 0.21, N = 112 matched pairs, P = 0.04). Beyond 6 years of follow-up, the HbA1c was not significantly lower in the pump cohort (N < 70 matched pairs). CONCLUSIONS Patients using insulin pump therapy had a better long-term glycemic control relative to the matched injection therapy cohort. Large population-based cohort studies using real-world data provide a valuable perspective on evaluation of new technologies in children with T1D.
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Affiliation(s)
- Marie-Anne Burckhardt
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Division of Paediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Grant J Smith
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Matthew N Cooper
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Timothy W Jones
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Division of Paediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Elizabeth A Davis
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Division of Paediatrics, Medical School, The University of Western Australia, Perth, Australia
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