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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: 52] [Impact Index Per Article: 26.0] [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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Mooney SP, Booth GL, Shulman R, Na Y, Weisman A, Shah BR, Perkins BA, Lipscombe L. Glycaemic control in transition-aged versus early adults with type 1 diabetes and the effect of a government-funded insulin pump programme. Diabet Med 2021; 38:e14618. [PMID: 34076916 DOI: 10.1111/dme.14618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/08/2021] [Accepted: 05/18/2021] [Indexed: 01/12/2023]
Abstract
AIM To compare glycaemic control and adverse outcomes between transition-aged and early adults with type 1 diabetes, and the impact of continuous subcutaneous insulin infusion (CSII) therapy funded through a government Assisted Devices Program. METHODS This retrospective cohort study using healthcare administrative databases from Ontario, Canada included adults aged 18-35 with type 1 diabetes between 1 April 2011 and 31 March 2014. Mean HbA1c was compared between transition-aged (18-24 years) and early adults (25-35 years), overall and stratified by whether or not they received government-funded CSII therapy (CSII vs. non-CSII). Secondary outcomes included rates of hospitalizations/emergency department visits for hyperglycaemia and hypoglycaemia over a 3-year follow-up. Comparisons were adjusted for relevant covariates. RESULTS Among 7157 participants with type 1 diabetes, mean HbA1c was significantly higher for transition-aged compared to early adults (71 mmol/mol [8.68%] vs. 64 mmol/mol [8.04%], p < 0.0001). This difference was smaller among CSII compared to non-CSII users (p = 0.02 for interaction between age group and CSII use). The transition-age group were more likely to experience a hyperglycaemic event compared to early adults (adjusted risk ratio, aRR: 1.56, 95% confidence interval [CI]: 1.25-1.96), which was attenuated by CSII use (aRR: 1.13, 95% CI: 0.7-1.69). CONCLUSIONS Transition-aged adults with type 1 diabetes had a significantly higher mean HbA1c and risk of hyperglycaemic events compared to early adults. This difference was attenuated for CSII users, indicating that a government-funded CSII programme is associated with narrowing of the gap in glycaemic control and associated adverse outcomes for this population.
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Affiliation(s)
- Shane P Mooney
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gillian L Booth
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Rayzel Shulman
- ICES, Toronto, ON, Canada
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yingbo Na
- ICES, Toronto, ON, Canada
- Department of Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Alanna Weisman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Department of Medicine, Sunnybrook, Toronto, ON, Canada
| | - Bruce A Perkins
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Lorraine Lipscombe
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Department of Medicine, Women's College Hospital, Toronto, ON, Canada
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Haddadi D, Rosolowsky E, Pacaud D, McKeen J, Young K, Madrick B, Domaschuk L, Sargious P, Conroy S, Senior PA. Revision of Alberta's Provincial Insulin Pump Therapy Criteria for Adults and Children With Type 1 Diabetes: Process, Rationale and Framework for Evaluation. Can J Diabetes 2020; 45:228-235.e4. [PMID: 33046399 DOI: 10.1016/j.jcjd.2020.08.097] [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] [Received: 11/25/2019] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Insulin pump therapy is a valuable, but costly approach, with public funding in Alberta for eligible individuals since 2013. The Provincial Insulin Pump Therapy Program Clinical Advisory Committee has revised and updated the clinical criteria, integrating current literature, best practice and feedback from clinicians. The objective was to develop criteria that would: 1) optimize safety and effectiveness of insulin pump therapy, while 2) carefully stewarding resources available to care for people with type 1 diabetes. METHODS The Clinical Advisory Committee comprised health-care professionals with expertise in pump therapy and included adult and pediatric endocrinologists, an internist, a pediatrician, certified pump trainers, diabetes educators and clinic managers. The group meets regularly by teleconference. Decisions are made by consensus. RESULTS Indications for insulin pump therapy for adults and children with insulin-deficient diabetes were divided into 4 hierarchical levels: 1) problematic hypoglycemia, inability to achieve acceptable control or progressive complications; 2) unpredictable activity, dawn phenomenon or children for whom use of multiple daily injections is not appropriate; 3) individual preference and 4) clinical exception, with priority given to indications with clear evidence of benefit. The criteria emphasize the importance of: 1) adequate education in diabetes self-management; 2) adequate trial of flexible insulin therapy with modern analogues and 3) evidence of active, safe diabetes self-management. Tools to facilitate effective and efficient annual review and surveillance were developed incorporating biological, behavioural evaluation and self-reflection to provide a framework for program evaluation. The recommendations were implemented in January 2019. CONCLUSIONS The process and revised criteria may be valuable for jurisdictions considering how to develop and implement a publicly funded insulin pump program.
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Affiliation(s)
- Dalal Haddadi
- Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Alberta, Canada
| | - Elizabeth Rosolowsky
- Division of Pediatric Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Danièle Pacaud
- Division of Pediatric Endocrinology, University of Calgary, Calgary, Alberta, Canada
| | - Julie McKeen
- Division of Endocrinology and Metabolism, University of Calgary, Calgary, Alberta, Canada
| | - Kim Young
- Nutrition Services, Alberta Health Services, Calgary, Alberta, Canada
| | - Bev Madrick
- Endocrinology & Metabolism Program, Alberta Health Services, Calgary, Alberta, Canada
| | - Lorelei Domaschuk
- Provincial Insulin Pump Therapy Program, Alberta Health Services, Lacombe, Alberta, Canada
| | - Peter Sargious
- Diabetes, Obesity, Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Sue Conroy
- Provincial Clinical Programs, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter A Senior
- Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Alberta, Canada.
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