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Estock JL, Codario RA, Zupa MF, Keddem S, Rodriguez KL. Insulin Pump Alarms During Adverse Events: A Qualitative Descriptive Study. J Diabetes Sci Technol 2023:19322968231209999. [PMID: 37905930 DOI: 10.1177/19322968231209999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Explore alarm signals cited in insulin pump-associated adverse events (AEs), describe the clinical consequences and other root cause informing remarks that cooccurred with the alarm signals, and identify opportunities for improvements to patient education, instructional materials, and alarm systems to prevent future AEs. RESEARCH DESIGN AND METHODS We explored the type, frequency, and associated clinical consequences of alarm signals cited in a pre-coded data set of 2294 insulin pump-associated AEs involving the MiniMed 670G, MiniMed 630G, and t:slim X2. We also explored the clinical consequences and other root cause informing remarks that cooccurred with the top 10 most frequently cited alarm signals. RESULTS Overall, 403 AEs narratives cited at least one alarm signal. Of the 40 unique alarm signals cited, 42.5% were "alarms," 25.0% were "alerts," and 32.5% were not referenced in the instructional materials packaged with the corresponding pump. The top 10 most frequently cited alarm signals included two obstruction of flow alarms, which accounted for 49.9% of all AEs citing at least one alarm, and two unreferenced alarms. The most frequent cooccurring root cause informing remark varied across the top 10 alarm signals and revealed valuable insight into why these alarms may have occurred. CONCLUSIONS Our findings demonstrate the value of analyzing alarm signals cited in insulin pump-associated AEs and reveal multiple opportunities for providers to educate patients on how to respond to alarm signals and manage their pumps to avoid AEs, and for insulin pump manufacturers to update instructional materials and improve alarm systems to support appropriate patient response.
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Affiliation(s)
- Jamie L Estock
- Office of Research and Development, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Ronald A Codario
- Department of Endocrinology, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Margaret F Zupa
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shimrit Keddem
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Family Medicine & Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Keri L Rodriguez
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
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Hirsch IB, Miller E. Integrating Continuous Glucose Monitoring Into Clinical Practices and Patients' Lives. Diabetes Technol Ther 2021; 23:S72-S80. [PMID: 34546085 DOI: 10.1089/dia.2021.0233] [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: 12/24/2022]
Abstract
Numerous studies have demonstrated the clinical benefits of continuous glucose monitoring (CGM) in individuals with diabetes. Within ongoing innovations in CGM technology, individuals now have an expanding array of options that allow them to select the device that meets their individual needs and preferences. Although demand for CGM in primary care continues to grow, many clinicians are reluctant to prescribe this technology due to their unfamiliarity with the various devices, uncertainty about which devices are best suited to each patient and the feasibility of using CGM. This article reviews the features and functionality of the most recent commercially available CGM devices and provides guidance for integrating CGM use into clinical practices.
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Affiliation(s)
- Irl B Hirsch
- Division of Metabolism, Endocrinology and Nutrition, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eden Miller
- Diabetes and Obesity Care, Bend, Oregon, USA
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Blissett DB, Attvall S, Hellmund RA. Analysis Estimating the Potential Cost Impact of Utilizing Flash Glucose Monitoring with Optional Alarms in Swedish Adults with Diabetes with Impaired Awareness of Hypoglycaemia, Using Intensive Insulin. Diabetes Ther 2021; 12:2179-2193. [PMID: 34232483 PMCID: PMC8342735 DOI: 10.1007/s13300-021-01099-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/10/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The objective of this analysis was to estimate the costs associated with using flash glucose monitoring with optional alarms as a replacement for either traditional continuous glucose monitoring (CGM) or routine self-monitoring of blood glucose (SMBG) in adults with diabetes and impaired awareness of hypoglycaemia (IAH) who use intensified insulin therapy, from a Swedish payer perspective, applying assumptions to simulate hypothetical scenarios. METHODS A simple two-state cohort Markov model was used to calculate the cost per patient treated over a 3-year period, capturing the risk of severe hypoglycaemic events requiring medical assistance and non-adherence using quarterly Markov cycles. The costs considered were those for glucose monitoring and resource use to treat severe hypoglycaemic events. Cost inputs were sourced from Swedish price lists, manufacturer data and resource use reported in the control arm of the HypoDE study. Targeted literature searches were run in PubMed to source the clinical inputs. Uncertainty in the model was considered through one-way sensitivity analysis and scenario analysis. RESULTS Over 3 years, flash monitoring with optional alarms resulted in potential cost-savings of Swedish krona (SEK) 7708 and SEK 69,908 per patient when compared to routine SMBG or CGM respectively. Sensitivity and scenario analyses were largely supportive of this conclusion with respect to SMBG, and large cost-savings were consistent across all sensitivity and scenario analyses with respect to CGM. CONCLUSION Utilizing flash monitoring with optional alarms is potentially a cost-saving treatment strategy compared to routine SMBG or traditional CGM in adults with diabetes using intensive insulin and IAH from a Swedish payer perspective. Future studies in the IAH population will help to assess more precisely the relative cost impact of flash glucose monitoring with optional alarms compared with SMBG and traditional CGM.
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Affiliation(s)
| | - Stig Attvall
- Diabetes, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Shang T, Zhang JY, Bequette BW, Raymond JK, Coté G, Sherr JL, Castle J, Pickup J, Pavlovic Y, Espinoza J, Messer LH, Heise T, Mendez CE, Kim S, Ginsberg BH, Masharani U, Galindo RJ, Klonoff DC. Diabetes Technology Meeting 2020. J Diabetes Sci Technol 2021; 15:916-960. [PMID: 34196228 PMCID: PMC8258529 DOI: 10.1177/19322968211016480] [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] [Indexed: 11/15/2022]
Abstract
Diabetes Technology Society hosted its annual Diabetes Technology Meeting on November 12 to November 14, 2020. This meeting brought together speakers to cover various perspectives about the field of diabetes technology. The meeting topics included artificial intelligence, digital health, telemedicine, glucose monitoring, regulatory trends, metrics for expressing glycemia, pharmaceuticals, automated insulin delivery systems, novel insulins, metrics for diabetes monitoring, and discriminatory aspects of diabetes technology. A live demonstration was presented.
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Affiliation(s)
- Trisha Shang
- Diabetes Technology Society, Burlingame, CA, USA
| | | | | | - Jennifer K. Raymond
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Gerard Coté
- Texas A & M University, College Station, Texas, USA
| | | | | | | | | | - Juan Espinoza
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Sarah Kim
- University of California San Francisco, San Francisco, CA, USA
| | | | - Umesh Masharani
- University of California San Francisco, San Francisco, CA, USA
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Buin E, Pavin EJ, Silveira MSVM. High anxiety and depressive symptoms in partners of type 1 diabetes persons in a sample of the Brazilian population. Diabetol Metab Syndr 2020; 12:23. [PMID: 32211074 PMCID: PMC7092427 DOI: 10.1186/s13098-020-00531-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/13/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) affects psychologically not only the persons with diabetes themselves but affects their family members. Few studies were conducted to investigate mental health in T1D partners. This study aims: (1) to investigate the frequency of depressive and anxiety symptoms in T1D partners and, (2) to investigate the associations among partners' depressive and anxiety symptoms and their sociodemographic and behavioral characteristics, and (3) to investigate the associations among partners' depressive and anxiety symptoms and clinical, laboratory and demographic characteristics of their T1D spouses in a Brazilian population. METHODS In a transversal study 72 T1D partners were interviewed. Partners were invited to take part in the study during their T1D spouses' routine consultations. Those who consented to take part in the study signed the consent form. This study followed the principles of the Declaration of Helsinki and was approved by the University Ethics in Research Committee. Inclusion criteria were T1D partners age ≥ 18 and T1D diagnosis > 6 months. Exclusion criteria were cognitive impairment, history of major psychiatric disorders, and severe chronic and terminal diseases. Depressive symptoms were evaluated by the depression subscale of the Hospital Anxiety and Depression scale (HADD) and anxiety symptoms were evaluated by the anxiety subscale of the same instrument (HADA). T1D partners were divided into subgroups according to score ≥ 8 and < 8 in both subscales. Demographic and clinical data were obtained from interview. Descriptive analyses were undertaken using means and percentages, as appropriate. Differences between groups were assessed by the Mann-Whitney test for numerical variables, by the Chi Square test or by Fisher's exact test for categorical variables, as appropriate. All analyses were undertaken using SAS version 9.2 for Windows. Statistical significance was set at 0.05. RESULTS Of all 72 T1D partners, 72.2% were male, mean age was 42.7 ± 14.1 years old, years of school attendance were 11.8 ± 3.9 years, and 48.5% had income reaching until 3 Brazilian minimal wages. Forty-three percent reported high anxiety symptoms (HADA ≥ 8) and 18.1% reported high depressive symptoms (HADD ≥ 8). Comparing T1D partners group with HADA ≥ 8 and < 8, the first one was associated with CGM use (41.94% vs 19.51%; p = 0.03). Similarly, comparing T1D partners group with HADD ≥ 8 and < 8, the first one was associated with (1) longer duration of T1D of their spouses (28.6 ± 7.1 vs 22.4 ± 12.2; p = 0.02); (2) less years of school attendance of T1D partners (9.3 ± 3.2 vs 12.3 ± 3.8; p = 0.02), and (3) higher number of hypoglycemic episodes requiring other person's intervention (6.3 ± 8.9 vs 2.4 ± 4.7; p = 0.009). Seventy-six percent of partners who helped personally in their spouses' hypoglycemia recovery had HADD ≥ 8 vs 44.7% with HADD < 8 (p = 0.03). Likewise, 84.6% vs 54.2% of partners in which their spouses have T1D chronic complications had HADD ≥ 8 and < 8, respectively (p = 0.04). CONCLUSION This study showed a high frequency of relevant anxiety and depressive symptoms in this T1D partner population. Several issues related to T1D of their spouses were associated with these symptoms. These results emphasize the need to incorporate the psychological and psychiatric aspects into T1D partners' education and care.
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Affiliation(s)
- E Buin
- 1Internal Medicine Postgraduate Program, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | - E J Pavin
- 2Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | - M S V M Silveira
- 2Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
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Mariani HS, Layden BT, Aleppo G. Continuous Glucose Monitoring: A Perspective on Its Past, Present, and Future Applications for Diabetes Management. Clin Diabetes 2017; 35:60-65. [PMID: 28144048 PMCID: PMC5241770 DOI: 10.2337/cd16-0008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Hanna S. Mariani
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Brian T. Layden
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Jesse Brown Veterans Affairs Medical Center, Chicago, IL
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Barnard K, James J, Kerr D, Adolfsson P, Runion A, Serbedzija G. Impact of Chronic Sleep Disturbance for People Living With T1 Diabetes. J Diabetes Sci Technol 2016; 10:762-7. [PMID: 26630914 PMCID: PMC5038531 DOI: 10.1177/1932296815619181] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM The aim was to explore personal experiences and to determine the impact of impaired sleep on well-being and diabetes-related activities/decision making among a cohort of people living with T1D. METHOD Adults with T1D over the age of 18 and parents/carers of children with T1D were invited to complete an online questionnaire about their quality and quantity of sleep. Questions included impact of sleep on diabetes-related decision making, effective calculation of bolus doses, important aspects of psychosocial functioning, and frequency of waking. Diasend download data were used to objectively determine frequency of nocturnal blood glucose testing in children. RESULTS A total of 258 parent/carer participants (n = 221 female, 85.6%) and 192 adults with T1D (n = 145, 75.5% female, age range 19 to 89 years) took part. In all, 239 parents/carers and 160 adults believed waking in the night has an impact on their usual daily functioning. Of these, 236 parents/carers and 151 (64%) adults reported the impact as negative. Chronic sleep interruption was associated with detrimental impact on mood, work, family relationships, ability to exercise regularly, ability to eat healthily, and happiness. CONCLUSION Chronic sleep interruption is highly prevalent in adults with T1D and parents/carers of children with T1D with negative effects on daily functioning and well-being. Appropriate interventions are required to alleviate this burden of T1D, address modifiable risk factors for nocturnal hypoglycemia, and reduce the (perceived) need for nocturnal waking.
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Affiliation(s)
- Katharine Barnard
- Faculty of Health & Social Science, Bournemouth University, Bournemouth, UK
| | - Janet James
- Faculty of Health & Social Science, Bournemouth University, Bournemouth, UK
| | - David Kerr
- William Sansum Diabetes Center, Santa Barbara, CA, USA
| | - Peter Adolfsson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Hospital of Halland, Kungsbacka, Sweden
| | - Asher Runion
- Unitio Inc and T1 Diabetes Exchange, Boston, MA, USA
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Polonsky WH, Hessler D. Perceived accuracy in continuous glucose monitoring: understanding the impact on patients. J Diabetes Sci Technol 2015; 9:339-41. [PMID: 25385947 PMCID: PMC4604572 DOI: 10.1177/1932296814559302] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In terms of accuracy and reliability, the technology of real-time (RT) continuous glucose monitoring (CGM) is advancing quickly. Still, current devices are imperfect; as a result, patient complaints and frustrations are not uncommon. How do patients' perceptions of device accuracy affect their experience with RT-CGM? In this article, we argue that patients' satisfaction, or dissatisfaction, with accuracy has a major impact on how much they are likely to trust the device and how confident they may feel in using the information that is displayed. The available data suggest that greater satisfaction with accuracy is linked to better RT-CGM adherence, more confident and aggressive insulin adjustments, improvements in quality of life, reduced reliance on self-monitoring of blood glucose, and--potentially--less alarm fatigue. As the technology continues to mature, RT-CGM will become increasingly accurate and patients' confidence and trust in the available devices will likely grow, leading to greater uptake and more proactive use of RT-CGM.
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Affiliation(s)
- William H Polonsky
- University of California, San Diego, San Diego, CA, USA Behavioral Diabetes Institute, San Diego, CA, USA
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