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Tecce N, Menafra D, Proganò M, Tecce MF, Pivonello R, Colao A. Evaluating the Impact of Continuous Glucose Monitoring on Erectile Dysfunction in Type 1 Diabetes: A Focus on Reducing Glucose Variability and Inflammation. Healthcare (Basel) 2024; 12:1823. [PMID: 39337164 PMCID: PMC11430976 DOI: 10.3390/healthcare12181823] [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: 07/25/2024] [Revised: 09/06/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
Type 1 diabetes (T1D) severely impairs metabolic control and can lead to erectile dysfunction (ED) through hyperglycemia-induced vascular damage, autonomic neuropathy, and psychological distress. This review examines the role of continuous glucose monitoring (CGM) in ameliorating ED by addressing glucose variability and inflammation. A comprehensive analysis of studies and clinical trials was conducted to evaluate the impact of CGM on metabolic control, inflammatory responses, and vascular health in patients with T1D. Evidence suggests that CGM systems significantly stabilize blood glucose levels and reduce hyper- and hypoglycemic episodes that contribute to endothelial dysfunction and ED. CGM's real-time feedback helps patients optimize metabolic control, improve vascular health, and reduce inflammation. CGM has the potential to redefine ED management in patients with T1D by improving glycemic control and reducing the physiological stressors that cause ED, potentially improving quality of life and sexual health. Further research is warranted to explore the specific benefits of CGM for ED management.
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Affiliation(s)
- Nicola Tecce
- Department of Clinical Medicine and Surgery, Department of Endocrinology, University Federico II of Naples, 80138 Naples, Italy; (D.M.); (M.P.); (R.P.); (A.C.)
| | - Davide Menafra
- Department of Clinical Medicine and Surgery, Department of Endocrinology, University Federico II of Naples, 80138 Naples, Italy; (D.M.); (M.P.); (R.P.); (A.C.)
| | - Mattia Proganò
- Department of Clinical Medicine and Surgery, Department of Endocrinology, University Federico II of Naples, 80138 Naples, Italy; (D.M.); (M.P.); (R.P.); (A.C.)
| | - Mario Felice Tecce
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Italy;
| | - Rosario Pivonello
- Department of Clinical Medicine and Surgery, Department of Endocrinology, University Federico II of Naples, 80138 Naples, Italy; (D.M.); (M.P.); (R.P.); (A.C.)
- UNESCO Chair for Health Education and Sustainable Development, University Federico II of Naples, 80138 Naples, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, Department of Endocrinology, University Federico II of Naples, 80138 Naples, Italy; (D.M.); (M.P.); (R.P.); (A.C.)
- UNESCO Chair for Health Education and Sustainable Development, University Federico II of Naples, 80138 Naples, Italy
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2
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Ajjan RA, Seidu S, Riveline JP. Perspective of Continuous Glucose Monitoring-Based Interventions at the Various Stages of Type 2 Diabetes. Diabetes Ther 2024; 15:1657-1672. [PMID: 38907936 PMCID: PMC11263446 DOI: 10.1007/s13300-024-01607-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/03/2024] [Indexed: 06/24/2024] Open
Abstract
Continuous glucose monitoring (CGM) is now advocated for the clinical management of individuals with type 1 diabetes (T1D). However, this glucose monitoring strategy is not routinely used in type 2 diabetes (T2D), given the large population, significant cost implications and relatively limited supporting evidence. T2D is a more heterogenous condition compared with T1D with various glucose lowering therapies that do not necessarily require CGM to ensure within target glucose levels. While all individuals with T2D may benefit from CGM at certain time points, the whole T2D population does not necessarily require this technology continuously, which should be prioritized based on patient benefit and cost effectiveness. In this pragmatic opinion piece, we describe the rationale and evidence for CGM use in different subgroups of individuals with T2d, divided according to the stage of the condition, glycemic therapies, presence of diabetes complications, or associated co-morbidities. We discuss a total of 16 T2D subgroups and provide a clinical view on CGM use in each, based on current evidence while also highlighting areas of knowledge gaps. This work provides health care professionals with a simple guide to CGM use in different T2D groups and gives suggestion for future studies to justify expansion of this technology.
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Affiliation(s)
- R A Ajjan
- Leeds Institute for Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK.
- St James's University Hospital, Leeds Teaching Hospitals Trust, Leeds, LS9 7TF, UK.
| | - S Seidu
- Diabetes Research Centre, Applied Research Collaboration East Midlands, National Institute for Health Research, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, National Institute for Health Research Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - J P Riveline
- Lariboisière Hospital, 2 Rue Ambroise Paré, 75010, Paris, France
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Tandon A, Avari Silva JN, Bhatt AB, Drummond CK, Hill AC, Paluch AE, Waits S, Zablah JE, Harris KC. Advancing Wearable Biosensors for Congenital Heart Disease: Patient and Clinician Perspectives: A Science Advisory From the American Heart Association. Circulation 2024; 149:e1134-e1142. [PMID: 38545775 DOI: 10.1161/cir.0000000000001225] [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: 05/08/2024]
Abstract
Wearable biosensors (wearables) enable continual, noninvasive physiologic and behavioral monitoring at home for those with pediatric or congenital heart disease. Wearables allow patients to access their personal data and monitor their health. Despite substantial technologic advances in recent years, issues with hardware design, data analysis, and integration into the clinical workflow prevent wearables from reaching their potential in high-risk congenital heart disease populations. This science advisory reviews the use of wearables in patients with congenital heart disease, how to improve these technologies for clinicians and patients, and ethical and regulatory considerations. Challenges related to the use of wearables are common to every clinical setting, but specific topics for consideration in congenital heart disease are highlighted.
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Horgan R, Hage Diab Y, Fishel Bartal M, Sibai BM, Saade G. Continuous Glucose Monitoring in Pregnancy. Obstet Gynecol 2024; 143:195-203. [PMID: 37769316 DOI: 10.1097/aog.0000000000005374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/06/2023] [Indexed: 09/30/2023]
Abstract
Diabetes mellitus in pregnancy is associated with adverse maternal and neonatal outcomes. Optimal glycemic control is associated with improved outcomes. Continuous glucose monitoring is a less invasive alternative to blood glucose measurements. Two types of continuous glucose monitoring are available in the market: real time and intermittently scanned. Continuous glucose monitoring is gaining popularity and is now recommended by some societies for glucose monitoring in pregnant women. In this review, we discuss the differences between the two types of continuous glucose monitoring, optimal treatment goals, and whether there is an improvement in maternal or neonatal outcomes.
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Affiliation(s)
- Rebecca Horgan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia; and the Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth Houston, Houston, Texas
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González-Pacheco H, Rivero-Santana A, Ramallo-Fariña Y, Valcárcel-Nazco C, Álvarez-Pérez Y, García-Pérez L, García-Bello MA, Perestelo-Pérez L, Serrano-Aguilar P. Effectiveness, safety and costs of the FreeStyle Libre glucose monitoring system for children and adolescents with type 1 diabetes in Spain: a prospective, uncontrolled, pre-post study. BMJ Open 2023; 13:e071334. [PMID: 38097245 PMCID: PMC10729222 DOI: 10.1136/bmjopen-2022-071334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the effectiveness, safety and costs of FreeStyle Libre (FSL) glucose monitoring system for children and adolescents with type 1 diabetes mellitus (T1DM) in Spain. DESIGN Prospective, multicentre pre-post study. SETTING Thirteen Spanish public hospitals recruited patients from January 2019 to March 2020, with a 12-month follow-up. PARTICIPANTS 156 patients were included. PRIMARY AND SECONDARY OUTCOME MEASURES Primary: glycated haemoglobin (HbA1c) change. Secondary: severe hypoglycaemic events (self-reported and clinical records), quality of life, diabetes treatment knowledge, treatment satisfaction, adverse events, adherence, sensor usage time and scans. Healthcare resource utilisation was assessed for cost analysis from the National Health System perspective, incorporating direct healthcare costs. Data analysis used mixed regression models with repeated measures. The intervention's total cost was estimated by multiplying health resource usage with unit costs. RESULTS In the whole sample, HbA1c increased significantly (0.32%; 95% CI 0.10% to 0.55%). In the subgroup with baseline HbA1c≥7.5% (n=88), there was a significant reduction at 3 months (-0.46%; 95% CI -0.69% to -0.23%), 6 months (-0.49%; 95% CI -0.73% to -0.25%) and 12 months (-0.43%; 95% CI -0.68% to -0.19%). Well-controlled patients had a significant 12-month worsening (0.32%; 95% CI 0.18% to 0.47%). Self-reported severe hypoglycaemia significantly decreased compared with the previous year for the whole sample (-0.37; 95% CI -0.62 to -0.11). Quality of life and diabetes treatment knowledge showed no significant differences, but satisfaction increased. Adolescents had lower sensor usage time and scans than children. Reduction in HbA1c was significantly associated with device adherence. No serious adverse effects were observed. Data suggest that use of FSL could reduce healthcare resource use (strips and lancets) and costs related to productivity loss. CONCLUSIONS The use of FSL in young patients with T1DM was associated with a significant reduction in severe hypoglycaemia, and improved HbA1c levels were seen in patients with poor baseline control. Findings suggest cost savings and productivity gains for caregivers. Causal evidence is limited due to the study design. Further research is needed to confirm results and assess risks, especially for patients with lower baseline HbA1c.
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Affiliation(s)
- Himar González-Pacheco
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Cristina Valcárcel-Nazco
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Yolanda Álvarez-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Lidia García-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Miguel Angel García-Bello
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Lilisbeth Perestelo-Pérez
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Services (SCS), Tenerife, Spain
| | - Pedro Serrano-Aguilar
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Services (SCS), Tenerife, Spain
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Gupta R, Edupuganti S, Zamir I, Singh A, Thawani HT. Latent Autoimmune Diabetes in Adults and a Continuous Glucose Monitoring Device: An Unfortunate Outcome. Cureus 2023; 15:e49141. [PMID: 38130540 PMCID: PMC10733160 DOI: 10.7759/cureus.49141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Latent autoimmune diabetes in adults (LADA) is a slow-progressing form of autoimmune diabetes. A 44-year-old man with a four-year history of diabetes mellitus (DM), obsessive-compulsive disorder (OCD), and panic disorder was admitted to the hospital for diabetic ketoacidosis. LADA was confirmed with positive GAD-65 antibody. His occupation involved random working days with several weeks off in between projects. During workdays, his insulin dosage required frequent adjustments due to lower blood glucose (BG) readings. Owing to the variable work schedule and constantly changing insulin needs, he was recommended a continuous glucose monitoring (CGM) device. Few days after starting on the CGM device, he was seen in the emergency department because of elevated BG. His home BG readings ranged from 80 to 408 mg/dL. He was getting frustrated with the fluctuating BG readings. At home, he remained agitated and endlessly checked his CGM device. After discharge, he would repeatedly call the endocrinology office with his BG readings with the insulin dose being adjusted accordingly. Few weeks later, the office received a call from his wife informing us that the patient had shot himself in the head. According to his wife, lately he had trouble sleeping, was very anxious, and often had panic attacks. He seemed to struggle with ever-fluctuating BG readings and was obsessed with incessantly changing numbers on his CGM device. Patients with Type 1 DM are at increased risk of mental health disorders and suicide forms a sizeable proportion of deaths in these patients. This case highlights the importance of mental health, especially underlying OCD as a prognostic factor in the management of diabetes with CGM devices.
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Affiliation(s)
- Rohit Gupta
- Internal Medicine and Pediatrics, Hurley Medical Center, Michigan State University, Flint, USA
| | - Srujan Edupuganti
- Internal Medicine and Pediatrics, Hurley Medical Center, Michigan State University, Flint, USA
| | - Irma Zamir
- Internal Medicine and Pediatrics, Hurley Medical Center, Michigan State University, Flint, USA
| | - Adiraj Singh
- Internal Medicine and Pediatrics, Hurley Medical Center, Michigan State University, Flint, USA
| | - Hemant T Thawani
- Endocrinology, Diabetes and Metabolism, Hurley Medical Center, Michigan State University, Flint, USA
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Ali N, El Hamdaoui S, Nefs G, Walburgh Schmidt JWJ, Tack CJ, de Galan BE. High diabetes-specific distress among adults with type 1 diabetes and impaired awareness of hypoglycaemia despite widespread use of sensor technology. Diabet Med 2023; 40:e15167. [PMID: 37347681 DOI: 10.1111/dme.15167] [Citation(s) in RCA: 1] [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] [Received: 04/24/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
AIMS Impaired awareness of hypoglycaemia (IAH) has been associated with increased diabetes distress and use of sensor technology can reduce diabetes distress. The aim of this study was to examine diabetes-specific distress (emotions, cognitions, behaviours) in relation to IAH status and use of glucose sensors in people with type 1 diabetes. METHODS Individuals with type 1 diabetes from an academic diabetes outpatient clinic completed the Clarke questionnaire (to assess hypoglycaemic awareness), Problem Areas in Diabetes (PAID-5), Hypoglycaemia Fear Survey-II (HFS-II), Attitudes to Awareness of Hypoglycaemia Survey (A2A), Nijmegen Clinical Screening Instrument Survey (NCSI) and Hyperglycaemia Avoidance Scale (HAS). RESULTS Of the 422 participants (51.9% male, diabetes duration 30 [16-40] years, HbA1c 60 ± 11 mmol/mol [7.6 ± 1.0%], 351 [88.2%] used a glucose sensor; 82 [19.4%]) had IAH. Compared to individuals with normal awareness, those with IAH more often had PAID-5 scores ≥8 (35.4% vs. 21.5%, p = 0.008) and higher scores on all HFS-II subscores (total [40.2 ± 21.5 vs. 27.9 ± 17.2, p < 0.001]), HFS-II behaviour (18.5 ± 10.0 vs. 15.1 ± 8.0, p = 0.005), HFS-II worry (21.8 ± 13.5 vs. 12.7 ± 10.9, p < 0.001), HAS worries (17.5 ± 7.3 vs. 14.3 ± 7.0, p < 0.001) and NCSI hypoglycaemia items. HAS behaviour, A2A and NCSI hyperglycaemia scores did not differ between individuals with or without IAH. Restricting the analyses to individuals using a glucose sensor did not materially change the results. CONCLUSIONS Diabetes-specific distress remains a major problem among individuals with type 1 diabetes, particularly those with IAH, despite the widespread use of (intermittently scanned) sensor technology. Further studies are needed to examine strategies to lower diabetes-specific distress in individuals with IAH.
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Affiliation(s)
- Namam Ali
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Soumia El Hamdaoui
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
- Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Diabeter, Center for Type 1 Diabetes Care and Research, Rotterdam, The Netherlands
| | | | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, The Netherlands
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Elian V, Popovici V, Ozon EA, Musuc AM, Fița AC, Rusu E, Radulian G, Lupuliasa D. Current Technologies for Managing Type 1 Diabetes Mellitus and Their Impact on Quality of Life-A Narrative Review. Life (Basel) 2023; 13:1663. [PMID: 37629520 PMCID: PMC10456000 DOI: 10.3390/life13081663] [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: 05/31/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
Type 1 diabetes mellitus is a chronic autoimmune disease that affects millions of people and generates high healthcare costs due to frequent complications when inappropriately managed. Our paper aimed to review the latest technologies used in T1DM management for better glycemic control and their impact on daily life for people with diabetes. Continuous glucose monitoring systems provide a better understanding of daily glycemic variations for children and adults and can be easily used. These systems diminish diabetes distress and improve diabetes control by decreasing hypoglycemia. Continuous subcutaneous insulin infusions have proven their benefits in selected patients. There is a tendency to use more complex systems, such as hybrid closed-loop systems that can modulate insulin infusion based on glycemic readings and artificial intelligence-based algorithms. It can help people manage the burdens associated with T1DM management, such as fear of hypoglycemia, exercising, and long-term complications. The future is promising and aims to develop more complex ways of automated control of glycemic levels to diminish the distress of individuals living with diabetes.
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Affiliation(s)
- Viviana Elian
- Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050471 Bucharest, Romania; (V.E.); (E.R.); (G.R.)
- Department of Diabetes, Nutrition and Metabolic Diseases, “Prof. Dr. N. C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 030167 Bucharest, Romania
| | - Violeta Popovici
- Department of Microbiology and Immunology, Faculty of Dental Medicine, Ovidius University of Constanta, 7 Ilarie Voronca Street, 900684 Constanta, Romania
| | - Emma-Adriana Ozon
- Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020945 Bucharest, Romania; (A.C.F.); (D.L.)
| | - Adina Magdalena Musuc
- Romanian Academy, “Ilie Murgulescu” Institute of Physical Chemistry, 202 Spl. Independentei, 060021 Bucharest, Romania;
| | - Ancuța Cătălina Fița
- Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020945 Bucharest, Romania; (A.C.F.); (D.L.)
| | - Emilia Rusu
- Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050471 Bucharest, Romania; (V.E.); (E.R.); (G.R.)
- Department of Diabetes, N. Malaxa Clinical Hospital, 12 Vergului Street, 022441 Bucharest, Romania
| | - Gabriela Radulian
- Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050471 Bucharest, Romania; (V.E.); (E.R.); (G.R.)
- Department of Diabetes, Nutrition and Metabolic Diseases, “Prof. Dr. N. C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 030167 Bucharest, Romania
| | - Dumitru Lupuliasa
- Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020945 Bucharest, Romania; (A.C.F.); (D.L.)
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Michou P, Gkiourtzis N, Christoforidis A, Kotanidou EP, Galli-Tsinopoulou A. The efficacy of automated insulin delivery systems in children and adolescents with Type 1 Diabetes Mellitus: a systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2023; 199:110678. [PMID: 37094750 DOI: 10.1016/j.diabres.2023.110678] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/28/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
AIMS Insulin administration is the treatment of choice for people with type 1 diabetes mellitus (T1D). Technological advances have led to the development of automated insulin delivery (AID) systems, aiming to optimize the quality of life of patients with T1D. We present a systematic review and meta-analysis of the current literature about the efficacy of AID systems in children and adolescents with T1D. METHODS We conducted a systematic literature search for randomized controlled trials (RCTs) until August 8th, 2022, investigating the efficacy of AID systems in the management of patients <21 years of age with T1D. A priori subgroup and sensitivity analyses based on different settings (free-living settings, type of AID system, parallel group or crossover design) were also conducted. RESULTS In total, 26 RCTs reporting a total of 915 children and adolescents with T1D were included in the meta-analysis. AID systems revealed statistically significant differences in the main outcomes, such as the proportion of time in the target glucose range (3.9-10 mmol/L) (p<0.00001), in hypoglycemia (<3.9 mmol/L) (p=0.003) and mean proportion of HbA1C (p=0.0007) compared to control group. CONCLUSIONS According to the present meta-analysis, AID systems are superior to insulin pump therapy, sensor-augmented pumps and multiple daily insulin injections. Most of the included studies have a high risk of bias because of allocation, blinding of patients and blinding of assessment. Our sensitivity analyses showed that patients <21 years of age with T1D can use AID systems, after proper education, following their daily activities. Further RCTs examining the effect of AID systems on nocturnal hypoglycemia, under free-living settings and studies examining the effect of dual-hormone AID systems are pending.
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Affiliation(s)
- Panagiota Michou
- Program of Postgraduate Studies Adolescent Medicine and Adolescent Health Care, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, 54124; Department of Pediatrics, Gennimatas General Hospital of Thessaloniki, Thessaloniki, Greece, 54635.
| | - Nikolaos Gkiourtzis
- 4th Department of Pediatrics, Papageorgiou General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, 56429.
| | - Athanasios Christoforidis
- 1st Department of Pediatrics, Ippokrateio General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, 54643.
| | - Eleni P Kotanidou
- Program of Postgraduate Studies Adolescent Medicine and Adolescent Health Care, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, 54124; 2nd Department of Pediatrics, AHEPA University General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, 54636.
| | - Asimina Galli-Tsinopoulou
- Program of Postgraduate Studies Adolescent Medicine and Adolescent Health Care, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, 54124; 2nd Department of Pediatrics, AHEPA University General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, 54636.
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10
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Gonynor C, Wang C, Tully C, Monaghan M, Streisand R, Hilliard ME. Psychosocial, Medical, and Demographic Variables Associated with Parent Mealtime Behavior in Young Children Recently Diagnosed with Type 1 Diabetes. J Dev Behav Pediatr 2023; 44:e111-e118. [PMID: 36730036 PMCID: PMC9908816 DOI: 10.1097/dbp.0000000000001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/04/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Managing young children's mealtime concerns can be challenging after type 1 diabetes (T1D) diagnosis because of developmental factors and diabetes management demands. To identify potential intervention targets, we evaluated medical, psychosocial, and demographic factors in relation to parents' engagement in problem mealtime behaviors (e.g., pressure to eat, restriction). METHOD Parents (N = 157) of young children (age 1-6 years) reported on psychosocial variables (parent fear of hypoglycemia, family functioning, parent problem solving, and parents' problem mealtime behavior frequency and perceptions of being problematic) within 2 months after T1D diagnosis. Hierarchical regression analyses examined associations among psychosocial variables, demographics (child sex, parent race/ethnicity), child continuous glucose monitor (CGM) use, and parents' problem mealtime behaviors. RESULTS Parents of children using CGMs reported parents' mealtime behaviors as more problematic than nonusers, but there were no differences for other medical or demographic variables. Models predicting parents' problem mealtime behavior frequency and problem perceptions that included psychosocial variables, demographic variables, and CGM use led to significant R 2 of 0.14 and 0.16, respectively. CGM use and parent problem solving were significantly associated with parent mealtime behaviors being perceived as more problematic. CONCLUSION Shortly after T1D diagnosis in young children, medical and parent psychosocial factors related to how frequently parents engaged in problem mealtime behaviors and the degree to which parents perceived them as problematic. Other factors may further explain the complexities of mealtime management. Considering parents' problem-solving skills and child treatment regimens may help guide interventions targeting mealtime challenges during the new diagnosis period.
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Affiliation(s)
- Caroline Gonynor
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX
- Texas A&M University, College Station, TX
| | - Christine Wang
- Children's National Hospital, Washington, DC; and
- The George Washington University School of Medicine, Washington, DC
| | - Carrie Tully
- Children's National Hospital, Washington, DC; and
- The George Washington University School of Medicine, Washington, DC
| | - Maureen Monaghan
- Children's National Hospital, Washington, DC; and
- The George Washington University School of Medicine, Washington, DC
| | - Randi Streisand
- Children's National Hospital, Washington, DC; and
- The George Washington University School of Medicine, Washington, DC
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX
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11
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Grundman JB, Majidi S, Perkins A, Streisand R, Monaghan M, Marks BE. Applying the use of shared medical appointments (SMAs) to improve continuous glucose monitor (CGM) use, glycemic control, and quality of life in marginalized youth with type 1 diabetes: Study protocol for a pilot prospective cohort study. Contemp Clin Trials Commun 2023; 32:101067. [PMID: 36698741 PMCID: PMC9868328 DOI: 10.1016/j.conctc.2023.101067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/08/2022] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
Background Continuous glucose monitors (CGMs) have been associated with improved glycemic control and diabetes-related quality of life in youth with type 1 diabetes (T1D), however use is lowest among youth from low-income households and racial/ethnic minorities. Shared medical appointments (SMAs) have been shown to improve glycemic control and reduce diabetes distress in adolescents with T1D, but a focus on marginalized youth has been lacking. This prospective cohort pilot study will assess feasibility and acceptability of the SMA intervention and impact on CGM uptake and sustained use, glycemic control, and diabetes distress in marginalized youth with elevated hemoglobin A1c (HbA1C). Methods The pilot study will recruit 20 publicly insured youth with T1D aged 8-12 years who identify as non-Hispanic Black or Latinx and have had at least one HbA1C value > 8% in the past year and their primary caretaker. The trial will employ an enrollment visit, SMA visits every 3 months over a 12-month study period, and a 6-month follow-up observational period. Feasibility measures include proportion of eligible youth successfully recruited for participation, proportion initiating CGM, SMA attendance, and retention through study completion. Acceptability will be assessed using satisfaction surveys. Changes in glycemic control will be assessed using CGM metrics and A1c from baseline to completion of the 12-month SMA intervention, as well as 3 and 6-months after completion of the SMA intervention. Conclusion Implementing SMAs for marginalized youth has the potential to address diabetes disparities by optimizing clinical and psychosocial outcomes for the most vulnerable youth living with T1D.Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05431686.
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Affiliation(s)
- Jody B. Grundman
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA,Corresponding author.
| | - Shideh Majidi
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA,George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - Amanda Perkins
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA
| | - Randi Streisand
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA,George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - Maureen Monaghan
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA
| | - Brynn E. Marks
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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12
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Limbert C, Tinti D, Malik F, Kosteria I, Messer L, Jalaludin MY, Benitez-Aguirre P, Biester S, Corathers S, von Sengbusch S, Marcovecchio ML. ISPAD Clinical Practice Consensus Guidelines 2022: The delivery of ambulatory diabetes care to children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1243-1269. [PMID: 36537530 DOI: 10.1111/pedi.13417] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Catarina Limbert
- Unit of Paediatric Endocrinology and Diabetes, Hospital Dona Estefânia, Lisbon, Portugal.,Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Davide Tinti
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Faisal Malik
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Ioanna Kosteria
- Department of Endocrinology, Growth & Development, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Laurel Messer
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Biester
- Diabetes-Center for Children and Adolescents, Children's Hospital "Auf der Bult", Hannover, Germany
| | - Sarah Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Simone von Sengbusch
- Division of Pediatric Endocrinology and Diabetology, Campus Lübeck, University Medical Centre Schleswig-Holstein, Lübeck, Germany
| | - M Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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13
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Tauschmann M, Forlenza G, Hood K, Cardona-Hernandez R, Giani E, Hendrieckx C, DeSalvo DJ, Laffel LM, Saboo B, Wheeler BJ, Laptev DN, Yarhere I, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Glucose monitoring. Pediatr Diabetes 2022; 23:1390-1405. [PMID: 36537528 PMCID: PMC10107687 DOI: 10.1111/pedi.13451] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Martin Tauschmann
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gregory Forlenza
- Pediatric Diabetes Division, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Korey Hood
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Elisa Giani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia Victoria, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Daniel J DeSalvo
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Lori M Laffel
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, Massachusetts, USA.,Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Banshi Saboo
- Department of Diabetology, Diabetes Care and Hormone Clinic, Ambawadi, Ahmedabad, Gujarat, India
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,Paediatrics Department, Southern District Health Board, Dunedin, New Zealand
| | | | - Iroro Yarhere
- Endocrinology Unit, Paediatrics Department, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
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14
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To become an expert within a week: Children's and parents' experiences of the child being diagnosed with type 1 diabetes and receiving diabetes education - A qualitative interview study. J Pediatr Nurs 2022; 67:e24-e30. [PMID: 36307293 DOI: 10.1016/j.pedn.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 10/01/2022] [Accepted: 10/11/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To explore children's and parents' experiences of the child being diagnosed with type 1 diabetes and receiving diabetes education during hospitalisation. DESIGN AND METHODS A qualitative interpretive design was applied. Semi-structured interviews with 15 children and their parent(s) were conducted. Data were analysed via thematic analysis. RESULTS The analysis revealed three themes: To be diagnosed with diabetes turns one's world upside down; It is positive to meet friendly and helpful healthcare professionals; and Diabetes education is overwhelming but required. CONCLUSIONS To be hospitalised and receive a diabetes diagnosis is overwhelming. The family must learn, in a short time, the basic skills to manage the condition. While learning, the child may fluctuate between being active and passive. In this vulnerable situation, it is positive to meet helpful healthcare professionals. Children find the motivation to learn, as they want to self-manage and be independent. All necessary education is given, but often the families would like to be more actively involved in the teaching. Sometimes, the teaching is also very compressed. PRACTICE IMPLICATIONS It is important to be aware of the vulnerable situation of the family and to adjust education to the fluctuations of the child. Teaching should be simplified and broken down stepwise, using pictures, artefacts, etc., to support the learning. More involvement may make education even more engaging and interesting. It has to be considered whether the education can be compressed into too short a time, making it difficult to transfer to the everyday lives of the families.
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15
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Hilliard ME, Commissariat PV, Kanapka L, Laffel LM, Levy W, Harrington K, Anderson BJ, Miller KM, DiMeglio LA. Development and delivery of a brief family behavioral intervention to support continuous glucose monitor use in young children with type 1 diabetes. Pediatr Diabetes 2022; 23:792-798. [PMID: 35446449 PMCID: PMC9542880 DOI: 10.1111/pedi.13349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/23/2022] [Accepted: 04/19/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite potential glycemic benefits of continuous glucose monitor (CGM) use in young children with type 1 diabetes, psychosocial and behavioral challenges may interfere with sustained use. We developed a 5-session family behavioral intervention (FBI) to support CGM use. OBJECTIVE We report on the multi-step development of the FBI, training interventionists, implementation in a 14-site clinical trial, and participant satisfaction. METHODS A multidisciplinary team created the FBI based on mixed-methods (i.e., survey data, qualitative research) preliminary work with parents of young children. Investigators trained non-physician staff to deliver the 5 sessions per an intervention manual. Trial participants received the FBI either during the first (FBI group, n = 50) or second 6-months (Crossover group, n = 44) of the 1-year trial. Investigators listened to session recordings to rate intervention fidelity, and participants rated satisfaction with the FBI. RESULTS The complete 5-session FBI was delivered to 89% of participants, in-person (73%) or by telephone (23%). Sessions lasted 23 min on average, and fidelity was high across sessions. Over 80% of participants rated very high satisfaction with all aspects of the FBI and offered few recommendations for improvement. CONCLUSIONS Having been developed based on experiences and input of families of young children with type 1 diabetes, the FBI represented a novel behavioral approach to enhance sustained CGM use during a challenging developmental period. Evidence of strong feasibility and acceptability supports its potential for implementation in research and clinical care. As diabetes technologies evolve, the FBI may continue to be refined to address parents' most relevant concerns.
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Affiliation(s)
| | | | | | - Lori M. Laffel
- Joslin Diabetes CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Wendy Levy
- Baylor College of Medicine and Texas Children's HospitalHoustonTexasUSA
| | - Kara Harrington
- Joslin Diabetes CenterHarvard Medical SchoolBostonMassachusettsUSA
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16
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Tanenbaum ML, Commissariat PV. Barriers and Facilitators to Diabetes Device Adoption for People with Type 1 Diabetes. Curr Diab Rep 2022; 22:291-299. [PMID: 35522355 PMCID: PMC9189072 DOI: 10.1007/s11892-022-01469-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Diabetes technology (insulin pumps, continuous glucose monitoring, automated insulin delivery systems) has advanced significantly and provides benefits to the user. This article reviews the current barriers to diabetes device adoption and sustained use, and outlines the known and potential facilitators for increasing and sustaining device adoption. RECENT FINDINGS Barriers to diabetes device adoption continue to exist at the system-, provider-, and individual-level. Known facilitators to promote sustained adoption include consistent insurance coverage, support for providers and clinics, structured education and support for technology users, and device user access to support as needed (e.g., through online resources). Systemic barriers to diabetes device adoption persist while growing evidence demonstrates the increasing benefits of newest devices and systems. There are ongoing efforts to develop evidence-based structured education programs to support device adoption and sustained use.
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Affiliation(s)
- Molly L Tanenbaum
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA.
| | - Persis V Commissariat
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA, USA
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17
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Schlueter S, Freckmann G, Wernsing M, Roelver KM, Joerdening M, Holder M, Heinemann L, Lange K. Development and Psychometric Assessment of a Manufacturer Independent Knowledge Questionnaire on Real Time Continuous Glucose Monitoring for insulin-treated People with Diabetes. DIABETOL STOFFWECHS 2022. [DOI: 10.1055/a-1492-5294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Background To benefit from real-time continuous glucose monitoring (rtCGM), users need practical skills and in-depth knowledge to analyze the glucose data appropriately and adapt insulin therapy accordingly. To assess the user’s knowledge about rtCGM, a psychometric knowledge test was developed and evaluated.
Method Experts on the use of rtCGM systems defined central knowledge contents in a Delphi process and developed a knowledge test comprising 40 multiple-choice items. For test-statistical review, people with insulin-treated diabetes and members of diabetes teams answered the knowledge test.
Results The 122 diabetes team members (age 46 (11) years; mean (SD)) and the 111 people with insulin-treated diabetes (age 42 (14) years, diabetes duration 20 (14) years, users of insulin pumps 64 %, previous usage of rtCGM 38 %, HbA1c 8.0 % [95 % CI 7.7–8.3] (64 mmol/mol [60–67]) had different levels of experiences using rtCGM systems. The internal consistency (Cronbach’s alpha) of the knowledge test was 0.92 for the whole sample, for people with diabetes 0.94, and for diabetes team members 0.84. Item difficulty ranged between 0.12 and 0.88 in people with diabetes and between 0.27 and 0.97 among diabetes team members. On average, people with diabetes answered 24.1 (9.9) items correctly, diabetes team members 29.2 (5.2) (p < 0.001); people with diabetes and previous rtCGM-experience had a higher knowledge compared to people without previous experience (29.2 (6.2) vs. 21.0 (10.4) (p = 0.001)). The quality of glucose control (measured by HbA1c) of the people with diabetes was significantly associated with the sum-score of the questionnaire (rho = –0.48, p < 0.001).
Conclusion The “rtCGM-Profi-Check” knowledge test provides high internal consistency, high selectivity, and content validity. It is suitable for objective, reliable, and valid assessment of the indispensable knowledge of people with diabetes to use different rtCGM systems successfully. The questionnaire is manufacturer-independent and is suitable to evaluate the needs and success of rtCGM education among persons with diabetes.
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Affiliation(s)
- Sandra Schlueter
- Medizinische Psychologie, Medizinische Hochschule Hannover, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Germany
| | - Marita Wernsing
- Diabeteszentrum, Christliches Krankenhaus Quakenbrück gemeinnützige GmbH, Quakenbrück, Germany
| | - Klaus-Martin Roelver
- Diabeteszentrum, Christliches Krankenhaus Quakenbrück gemeinnützige GmbH, Quakenbrück, Germany
| | - Mia Joerdening
- Medizinische Psychologie, Medizinische Hochschule Hannover, Germany
| | - Martin Holder
- Kinderklinik, Klinikum Stuttgart Olgahospital, Stuttgart, Germany
| | | | - Karin Lange
- Medizinische Psychologie, Medizinische Hochschule Hannover, Germany
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18
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Huhn F, Lange K, Jördening M, Ernst G. Real-World Use of Continuous Glucose Monitoring (CGM) Systems Among Adolescents and Young Adults With Type 1 Diabetes: Reduced Burden, but Little Interest in Data Analysis. J Diabetes Sci Technol 2022:19322968221081216. [PMID: 35255729 DOI: 10.1177/19322968221081216] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since 2016, German health insurance companies reimburse continuous glucose monitoring (CGM) systems for persons with insulin-dependent diabetes, leading to a tremendous increase of CGM use. This study assessed the use of CGM, the satisfaction with, and the data analysis behavior among young people. METHODS During a diabetes camp for young people from all over Germany, participants anonymously answered a questionnaire on their method of glucose monitoring, satisfaction and quality of CGM use, HbA1c, and diabetes distress (Problem Areas in Diabetes Scale [PAID]-5). RESULTS A total of 308 participants (age 21.4 ± 3.5 years; 73% female; diabetes duration 10.1 ± 5.9 years) completed the questionnaire. Approximately, 25% used self-monitoring of blood glucose (SMBG), 46% intermittent-scanning continuous glucose monitoring (iscCGM), and 30% real-time continuous glucose monitoring (rtCGM). Mean HbA1c was slightly, but not significantly, higher among SMBG users compared with CGM users (8.0% ± 1.9% vs. 7.7% ± 1.4%; P = .791). Diabetes distress was not associated with the method of glucose monitoring (SMBG 5.6 vs. iscCGM 6.2 vs. rtCGM 6.5; P = .386). Overall, satisfaction with CGM use was very high; 98% of the CGM users reported better well-being with CGM compared with previous SMBG use. Only 19% of CGM users reported regular data analyses; their HbA1c was lower compared with other CGM users (7.2% ± 1.2% vs. 7.7% ± 1.4%; P = .039). CONCLUSIONS In this large sample of young people, 75% were using a CGM system. Treatment satisfaction was very high, but CGM use was not associated with reduced diabetes distress or better glycemic control. However, young people who regularly analyzed their CGM data reported lower HbA1c levels.
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Affiliation(s)
- Friederike Huhn
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Mia Jördening
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Gundula Ernst
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
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19
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Maahs DM, Addala A, Shalitin S. Diabetes Technology and Therapy in the Pediatric Age Group. Diabetes Technol Ther 2022; 24:S107-S128. [PMID: 35475702 DOI: 10.1089/dia.2022.2507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- David M Maahs
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
- Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA
| | - Ananta Addala
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
| | - Shlomit Shalitin
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Hobbs A, Thus M, Couper J, Tham E, Fairchild J. Does introduction of continuous glucose monitoring at diagnosis of type 1 diabetes increase uptake in children and adolescents? Pediatr Diabetes 2022; 23:98-103. [PMID: 34820964 DOI: 10.1111/pedi.13293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/05/2021] [Accepted: 11/14/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess whether introduction of continuous glucose monitoring (CGM) at diagnosis of type 1 diabetes (T1D), leads to greater uptake and continuation at 12 and 24 months, in a population-based pediatric diabetes clinic. RESEARCH DESIGN AND METHODS All T1D children and adolescents diagnosed in the 12 months following full government subsidization of CGM were offered CGM from diagnosis at Women's and Children's Hospital, SA (Cohort 1). Uptake and continuation of CGM was compared to those diagnosed in the preceding year, who were started on CGM after diagnosis, but otherwise had identical diabetes management (Cohort 2). Demographic and clinical data were collected prospectively. The primary outcome variable was CGM wear >75% of the time at 12 and 24 months. RESULTS In Cohort 1, 84% were started on CGM at diagnosis. 88% had commenced CGM by 12 months and 90% by 24 months. In Cohort 2, CGM was started on average 10 months after diagnosis (range 1-25 months), with 81% started on CGM within 24 months of subsidization. At 24 months, 78% of Cohort 1 and 66% of Cohort 2 were wearing CGM >75% of the time (p = 0.26), higher than the WCH Clinic as a whole (58%). There was no difference in HbA1c between cohorts. CONCLUSION Starting CGM at diagnosis of T1D is feasible and well received by families, with high uptake across all ages. Although CGM continuation (wearing CGM >75% of the time) was slightly higher in Cohort 1 than Cohort 2, this did not reach statistical significance.
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Affiliation(s)
- Annabelle Hobbs
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Maree Thus
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jennifer Couper
- Women's and Children's Hospital, Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Elaine Tham
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jan Fairchild
- Women's and Children's Hospital, Adelaide, South Australia, Australia
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21
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Elbarbary N, Moser O, Al yaarubi S, Alsaffar H, Al Shaikh A, Ajjan RA, Deeb A. Use of continuous glucose monitoring trend arrows in the younger population with type 1 diabetes. Diab Vasc Dis Res 2021; 18:14791641211062155. [PMID: 34898300 PMCID: PMC8671682 DOI: 10.1177/14791641211062155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Early control of glycaemia is key to reduce vascular complications in individuals with Type 1 diabetes. Therefore, encouraging children and adolescents with T1DM to take responsibility for controlling glucose levels is an important yet a challenging task. The rapid expansion of continuous glucose monitoring (CGM) systems has allowed for more comprehensive analysis of glycaemia in T1D. Moreover, CGM devices have the ability to calculate rate of change in glucose levels and display the information as trend arrows. In turn, this can help to take evasive actions to return glucose levels to near physiological glycaemia, which can be highly motivating for young people with T1DM. In the absence of standardised, evidence-based guidance, this consensus document, generated by experts from the Arab Society of Paediatric Endocrinology and Diabetes and international advisors, summarises recent literature on the use of trend arrows in young people with T1DM. The use of trend arrows in different CGM systems is reviewed and their clinical significance is highlighted. Adjusting insulin doses according to trend arrows is discussed while also addressing special situations, such as exercise, fasting, nocturnal hypoglycaemia and menstruation. Adequate understanding of trend arrows should facilitate optimisation of glycaemic control in the T1D population.
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Affiliation(s)
- Nancy Elbarbary
- Diabetes Unit, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Nancy Elbarbary, Professor of Pediatrics, Department of Pediatrics, Diabetes Unit, Faculty of Medicine, Ain Shams University, 25 Ahmed Fuad St. Saint Fatima, Heliopolis, Cairo 11361, Egypt.
| | - Othmar Moser
- Division Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Saif Al yaarubi
- Pediatric Endocrine Department, Sultan Qaboos University Hospital, College of Medicine, Seeb, Oman
| | - Hussain Alsaffar
- Paediatric Endocrine and Diabetics Unit, Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Adnan Al Shaikh
- Pediatric Department, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Asma Deeb
- Paediatric Endocrinology Department, Sheikh Shakhbout Medical City and Khalifa University Abu Dhabi, Abu Dhabi, UAE
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Tanenbaum ML, Messer LH, Wu CA, Basina M, Buckingham BA, Hessler D, Mulvaney SA, Maahs DM, Hood KK. Help when you need it: Perspectives of adults with T1D on the support and training they would have wanted when starting CGM. Diabetes Res Clin Pract 2021; 180:109048. [PMID: 34534592 PMCID: PMC8578423 DOI: 10.1016/j.diabres.2021.109048] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/30/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
AIMS The purpose of this study was to explore preferences that adults with type 1 diabetes (T1D) have for training and support to initiate and sustain optimal use of continuous glucose monitoring (CGM) technology. METHODS Twenty-two adults with T1D (M age 30.95 ± 8.32; 59.1% female; 90.9% Non-Hispanic; 86.4% White; diabetes duration 13.5 ± 8.42 years; 72.7% insulin pump users) who had initiated CGM use in the past year participated in focus groups exploring two overarching questions: (1) What helped you learn to use your CGM? and (2) What additional support would you have wanted? Focus groups used a semi-structured interview guide and were recorded, transcribed and analyzed. RESULTS Overarching themes identified were: (1) "I got it going by myself": CGM training left to the individual; (2) Internet as diabetes educator, troubleshooter, and peer support system; and (3) domains of support they wanted, including content and format of this support. CONCLUSION This study identifies current gaps in training and potential avenues for enhancing device education and CGM onboarding support for adults with T1D. Providing CGM users with relevant, timely resources and attending to the emotional side of using CGM could alleviate the burden of starting a new device and promote sustained device use.
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Affiliation(s)
- Molly L Tanenbaum
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA; Stanford Diabetes Research Center, Stanford, CA, USA.
| | - Laurel H Messer
- University of Colorado Anschutz, Barbara Davis Center for Childhood Diabetes, Aurora, CO, USA.
| | - Christine A Wu
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA.
| | - Marina Basina
- Stanford Diabetes Research Center, Stanford, CA, USA; Division of Endocrinology, Gerontology, & Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Bruce A Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA; Stanford Diabetes Research Center, Stanford, CA, USA.
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Shelagh A Mulvaney
- Center for Diabetes Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA; School of Nursing, Vanderbilt University, Nashville, TN, USA.
| | - David M Maahs
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA; Stanford Diabetes Research Center, Stanford, CA, USA.
| | - Korey K Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA; Stanford Diabetes Research Center, Stanford, CA, USA.
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Fremont ER, Slick N, Willi SM, Miller VA. "I Think Parents Shouldn't Be Too Pushy": A Qualitative Exploration of Parent and Youth Perspectives of Youth Decision-Making Involvement in Starting Continuous Glucose Monitoring. Sci Diabetes Self Manag Care 2021; 47:355-366. [PMID: 34448420 DOI: 10.1177/26350106211040424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this qualitative study was to explore parent and youth perspectives of the decision-making process to start continuous glucose monitoring (CGM). METHODS Youth with type 1 diabetes and their parents were assessed with semistructured interviews before adding CGM to their regimen and 2 months after device initiation. Interviews focused on parent, youth, and provider decision-making roles and suggestions for enhancing youth decision-making involvement (DMI). Data were coded and analyzed using thematic analysis. RESULTS Youth (N = 41; 13.7 ± 2.9 years) were categorized into decision-making roles: (1) youth primary decision maker (54.8%), (2) youth primary decision maker with parental influence (14.3%), (3) parent primary decision maker with youth agreement (26.2%), and (4) parent primary decision maker without youth agreement (4.8%). Participants described that clinicians provided information, recommended CGM, and gave support. Recommendations to enhance youth DMI included that youth should ask questions, express opinions, and do their own research. Providers should give unbiased information and use visual aids (eg, show the device and videos) to engage youth. CONCLUSIONS Participants agreed that whereas youth should have a primary role in the decision about CGM, parental and provider support is critical. Parents and providers can facilitate dialogue by directly engaging with youth about their thoughts, feelings, and concerns. Provider use of visual aids may enhance youth engagement and expectations.
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Affiliation(s)
- Ettya R Fremont
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nathalie Slick
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven M Willi
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria A Miller
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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24
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Yu J, Chiu C, Wang Y, Dzubur E, Lu W, Hoffman J. A Machine Learning Approach to Passively Informed Prediction of Mental Health Risk in People with Diabetes: Retrospective Case-Control Analysis. J Med Internet Res 2021; 23:e27709. [PMID: 34448707 PMCID: PMC8433872 DOI: 10.2196/27709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/22/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Proactive detection of mental health needs among people with diabetes mellitus could facilitate early intervention, improve overall health and quality of life, and reduce individual and societal health and economic burdens. Passive sensing and ecological momentary assessment are relatively newer methods that may be leveraged for such proactive detection. Objective The primary aim of this study was to conceptualize, develop, and evaluate a novel machine learning approach for predicting mental health risk in people with diabetes mellitus. Methods A retrospective study was designed to develop and evaluate a machine learning model, utilizing data collected from 142,432 individuals with diabetes enrolled in the Livongo for Diabetes program. First, participants’ mental health statuses were verified using prescription and medical and pharmacy claims data. Next, four categories of passive sensing signals were extracted from the participants’ behavior in the program, including demographics and glucometer, coaching, and event data. Data sets were then assembled to create participant-period instances, and descriptive analyses were conducted to understand the correlation between mental health status and passive sensing signals. Passive sensing signals were then entered into the model to train and test its performance. The model was evaluated based on seven measures: sensitivity, specificity, precision, area under the curve, F1 score, accuracy, and confusion matrix. SHapley Additive exPlanations (SHAP) values were computed to determine the importance of individual signals. Results In the training (and validation) and three subsequent test sets, the model achieved a confidence score greater than 0.5 for sensitivity, specificity, area under the curve, and accuracy. Signals identified as important by SHAP values included demographics such as race and gender, participant’s emotional state during blood glucose checks, time of day of blood glucose checks, blood glucose values, and interaction with the Livongo mobile app and web platform. Conclusions Results of this study demonstrate the utility of a passively informed mental health risk algorithm and invite further exploration to identify additional signals and determine when and where such algorithms should be deployed.
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Affiliation(s)
- Jessica Yu
- Livongo Health, Inc, Mountain View, CA, United States
| | - Carter Chiu
- Livongo Health, Inc, Mountain View, CA, United States
| | - Yajuan Wang
- Livongo Health, Inc, Mountain View, CA, United States
| | - Eldin Dzubur
- Livongo Health, Inc, Mountain View, CA, United States
| | - Wei Lu
- Livongo Health, Inc, Mountain View, CA, United States
| | - Julia Hoffman
- Livongo Health, Inc, Mountain View, CA, United States
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25
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Barbed Ferrández SM, Montaner Gutiérrez T, Larramona Ballarín G, Ferrer Lozano M, Lou Francés GM. Impact on the well-being perceived by caregivers of children and adolescents with type 1 diabetes following the use of interstitial glucose measurement systems. ENDOCRINOL DIAB NUTR 2021; 68:243-250. [PMID: 34266636 DOI: 10.1016/j.endien.2019.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/22/2019] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Type 1 diabetes mellitus (DM-1) is one of the most common chronic childhood diseases, and it is essential to optimize glycemic control in order to avoid complications. For years, interstitial glucose measurement systems (MGI systems) have been among the new technologies at the forefront of self-care. OBJECTIVES To determine the impact on the well-being of the caregivers of patients with DM-1 under 18 years of age, controlled at a Pediatric Diabetes Unit of a third level hospital, of the use of MGI systems. MATERIAL AND METHODS This was an observational, descriptive and analytical cohort study based on a questionnaire completed by the patients' caregivers, as well as from the patient's clinical history. RESULTS There were 120 participants (55.5% males), with a mean age 13.20 +/- 3.71 years and mean glycosylated haemoglobin (HbA1c) 7.36% +/- 0.90. 52.5% of the sample used MGI systems. The caregivers of patients using MGI systems showed significantly higher scores (p < 0.05) regarding well-being, compared to the caregivers of patients not using this technology. In the former, a significant improvement (p < 0.05) in these variables with respect to the values prior to the beginning of their use was observed. CONCLUSIONS The use of MGI systems for diabetes self-management in our study led to a greater sense of well-being on the part of caregivers compared with before their introduction, as well as in comparison with those who continued to perform measurements using daily capillary glycemias.
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26
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Al-Gadi I, Menon S, Lyons SK, DeSalvo DJ. Beyond A1C: A Practical Approach to Interpreting and Optimizing Continuous Glucose Data in Youth. Diabetes Spectr 2021; 34:139-148. [PMID: 34149254 PMCID: PMC8178721 DOI: 10.2337/ds20-0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite significant pharmacological and technological advances in the treatment of type 1 diabetes, the majority of youth in the United States do not meet the American Diabetes Association's recommended A1C goal. Understanding and managing glycemic variability is important in children and adolescents. Because A1C provides an incomplete picture of day-to-day glycemic fluctuations, continuous glucose monitoring (CGM)-derived metrics are a promising addition to address glycemic management challenges in youth with diabetes. In this article, we discuss how to develop practical strategies to optimize the use of CGM in the pediatric population, interpret the valuable data it provides, and develop personalized and actionable treatment goals.
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Affiliation(s)
- Iman Al-Gadi
- Department of Pediatrics, Section of Diabetes and Endocrinology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Sruthi Menon
- Department of Pediatrics, Section of Diabetes and Endocrinology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Sarah K Lyons
- Department of Pediatrics, Section of Diabetes and Endocrinology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Daniel J DeSalvo
- Department of Pediatrics, Section of Diabetes and Endocrinology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
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27
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Lawson ML, Verbeeten KC, Courtney JM, Bradley BJ, McAssey K, Clarson C, Kirsch S, Curtis JR, Mahmud FH, Richardson C, Cooper T, Chan J, Tang K. Timing of CGM initiation in pediatric diabetes: The CGM TIME Trial. Pediatr Diabetes 2021; 22:279-287. [PMID: 33098212 PMCID: PMC7984035 DOI: 10.1111/pedi.13144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/18/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To determine whether timing of CGM initiation offering low glucose suspend (LGS) affects CGM adherence in children and youth starting insulin pump therapy. METHODS A 5-site RCT of pump-naïve subjects (aged 5-18 years) with type 1 diabetes (T1D) for at least 1 year compared simultaneous pump and CGM initiation offering LGS vs standard pump therapy with CGM initiation delayed for 6 months. Primary outcome was CGM adherence (hours per 28 days) (MiniMed™ Paradigm™ Veo™ system; CareLink Pro™ software) over 6 months after CGM initiation. Secondary outcome HbA1c was measured centrally. Linear mixed-models and ordinary least squares models were fitted to estimate effect of intervention, and covariates baseline age, T1D duration, HbA1c, gender, ethnicity, hypoglycemia history, clinical site, and association between CGM adherence and HbA1c. RESULTS The trial randomized 144/152 (95%) eligible subjects. Baseline mean age was 11.5 ± 3.3(SD) years, T1D duration 3.4 ± 3.1 years, and HbA1c 7.9 ± 0.9%. Six months after CGM initiation, adjusted mean difference in CGM adherence was 62.4 hours per 28 days greater in the Simultaneous Group compared to Delayed Group (P = .007). There was no difference in mean HbA1c at 6 months. However, for each 100 hours of CGM use per 28-day period, HbA1c was 0.39% (95% CI 0.10%-0.69%) lower. Higher CGM adherence was associated with reduced time with glucose >10 mmol/L (P < .001). CONCLUSION CGM adherence was higher after 6 months when initiated at same time as pump therapy compared to starting CGM 6 months after pump therapy. Greater CGM adherence was associated with improved HbA1c.
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Affiliation(s)
- Margaret L. Lawson
- Division of Endocrinology and Metabolism, Department of PediatricsChildren's Hospital of Eastern OntarioOttawaOntarioCanada,Clinical Research UnitCHEO Research InstituteOttawaOntarioCanada
| | - Kate C. Verbeeten
- Division of Endocrinology and Metabolism, Department of PediatricsChildren's Hospital of Eastern OntarioOttawaOntarioCanada,Clinical Research UnitCHEO Research InstituteOttawaOntarioCanada
| | | | | | - Karen McAssey
- Department of PediatricsMcMaster Children's HospitalHamiltonOntarioCanada
| | - Cheril Clarson
- Department of Pediatrics, Children's Hospital, London Health Sciences CentreLawson Health Research InstituteLondonOntarioCanada
| | - Susan Kirsch
- Department of PediatricsMarkham‐Stouffville HospitalMarkhamOntarioCanada
| | - Jacqueline R Curtis
- Division of Endocrinology, Department of PediatricsHospital for Sick ChildrenTorontoOntarioCanada
| | - Farid H Mahmud
- Division of Endocrinology, Department of PediatricsHospital for Sick ChildrenTorontoOntarioCanada
| | - Christine Richardson
- Division of Endocrinology and Metabolism, Department of PediatricsChildren's Hospital of Eastern OntarioOttawaOntarioCanada
| | - Tammy Cooper
- Division of Endocrinology and Metabolism, Department of PediatricsChildren's Hospital of Eastern OntarioOttawaOntarioCanada
| | - Jason Chan
- Clinical Research UnitCHEO Research InstituteOttawaOntarioCanada
| | - Ken Tang
- Clinical Research UnitCHEO Research InstituteOttawaOntarioCanada
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28
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Brew-Sam N, Chhabra M, Parkinson A, Hannan K, Brown E, Pedley L, Brown K, Wright K, Pedley E, Nolan CJ, Phillips C, Suominen H, Tricoli A, Desborough J. Experiences of Young People and Their Caregivers of Using Technology to Manage Type 1 Diabetes Mellitus: Systematic Literature Review and Narrative Synthesis. JMIR Diabetes 2021; 6:e20973. [PMID: 33528374 PMCID: PMC7886614 DOI: 10.2196/20973] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/23/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In the last decade, diabetes management has begun to transition to technology-based care, with young people being the focus of many technological advances. Yet, detailed insights into the experiences of young people and their caregivers of using technology to manage type 1 diabetes mellitus are lacking. OBJECTIVE The objective of our study was to describe the breadth of experiences and perspectives on diabetes technology use among children and adolescents with type 1 diabetes mellitus and their caregivers. METHODS This systematic literature review used integrated thematic analysis to guide a narrative synthesis of the included studies. We analyzed the perspectives and experiences of young people with type 1 diabetes mellitus and their caregivers reported in qualitative studies, quantitative descriptive studies, and studies with a mixed methods design. RESULTS Seventeen articles met the inclusion criteria, and they included studies on insulin pump, glucose sensors, and remote monitoring systems. The following eight themes were derived from the analysis: (1) expectations of the technology prior to use, (2) perceived impact on sleep and overnight experiences, (3) experiences with alarms, (4) impact on independence and relationships, (5) perceived usage impact on blood glucose control, (6) device design and features, (7) financial cost, and (8) user satisfaction. While many advantages of using diabetes technology were reported, several challenges for its use were also reported, such as cost, the size and visibility of devices, and the intrusiveness of alarms, which drew attention to the fact that the user had type 1 diabetes mellitus. Continued use of diabetes technology was underpinned by its benefits outweighing its challenges, especially among younger people. CONCLUSIONS Diabetes technologies have improved the quality of life of many young people with type 1 diabetes mellitus and their caregivers. Future design needs to consider the impact of these technologies on relationships between young people and their caregivers, and the impact of device features and characteristics such as size, ease of use, and cost.
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Affiliation(s)
- Nicola Brew-Sam
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Madhur Chhabra
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Kristal Hannan
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Ellen Brown
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Lachlan Pedley
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Karen Brown
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Kristine Wright
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Elizabeth Pedley
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Christopher J Nolan
- Canberra Health Services, Canberra, Australia.,ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia.,The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Hanna Suominen
- School of Computing, College of Engineering and Computer Science, Australian National University, Canberra, Australia.,Department of Computing, University of Turku, Turku, Finland.,Data61, Commonwealth Scientific and Industrial Research Organisation, Canberra, Australia
| | - Antonio Tricoli
- The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australia.,Nanotechnology Research Lab, Research School of Chemistry, College of Science, Australian National University, Canberra, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
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29
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Franceschi R, Micheli F, Mozzillo E, Cauvin V, Liguori A, Soffiati M, Giani E. Intermittently Scanned and Continuous Glucose Monitor Systems: A Systematic Review on Psychological Outcomes in Pediatric Patients. Front Pediatr 2021; 9:660173. [PMID: 34026692 PMCID: PMC8131655 DOI: 10.3389/fped.2021.660173] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
Abstract
Aim: To explore the impact of real-time continuous glucose monitoring (rtCGMs) or intermittently scanned/viewed CGM (isCGM) on psychological outcomes in children and caregivers, and to grade the level of evidence. Method: Systematic review of the literature from PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Nursing reference center, Up to date, Google Scholar, and PsycINFO databases. The studies selected used validated questionnaires for investigating the psychological outcomes. We applied GRADE (Grading of Recommendations Assessment, Development and Evaluation) to rank the quality of a body of evidence. Results: A total of 192 studies were identified in the initial search and after the process of evaluation 25 studies were selected as appropriate to be included in this systematic review. We found in moderate quality studies that isCGM in adolescents can improve diabetes related distress, family conflicts, fear of hypoglycemia, and quality of life, while depression, anxiety, and quality of sleep have not yet been evaluated by validated questionnaires. In moderate-high quality studies, rtCGM technology does not impact on diabetes burden, diabetes specific family conflict, and depressive symptoms. The effect on fear of hypoglycemia, sleep quality, and anxiety is still debated and RCT studies powered to find significant results in psychological outcomes are lacking. RtCGM increases satisfaction and quality of life in parents and patients wearing rtCGM. Conclusion: these data present an interesting point to consider when families are deciding whether or not to start CGM use, choosing between rtCGM to reach a tighter metabolic control, or isCGM which allows greater benefits on psychological outcomes.
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Affiliation(s)
| | | | - Enza Mozzillo
- Section of Pediatrics, Department of Translational Medical Science, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | | | | | | | - Elisa Giani
- Humanitas Clinical and Research Center, Rozzano, Italy
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30
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Kubihal S, Goyal A, Gupta Y, Khadgawat R. Glucose measurement in body fluids: A ready reckoner for clinicians. Diabetes Metab Syndr 2021; 15:45-53. [PMID: 33310176 DOI: 10.1016/j.dsx.2020.11.021] [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: 10/31/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Blood glucose measurement is central to the diagnosis and management of patients with diabetes. Considering that a clinician relies heavily on blood (or rarely other body fluid) glucose values for decision making, an understanding of the basic aspects of glucose measurement in body fluids is necessary. METHODS A literature search was conducted in PubMed for articles in English on measurement of glucose in body fluids. RESULTS Glucose can be measured in several body fluids, namely blood, interstitial fluid, urine, cerebrospinal fluid, pleural fluid and ascitic fluid in appropriate clinical settings. For blood glucose measurement, the present-day enzymatic methods have replaced the older reducing and condensation methods on account of their better accuracy. It is important to consider preanalytical factors such as sample collection, storage and transport when analyzing a laboratory blood glucose report. The measurement of glucose in interstitial fluid using continuous glucose monitoring system (CGMS) enables better understanding of glucose trends and fluctuations. The CGMS data should be reported using standard metrics which include parameters such as mean 24-h glucose, glycemic variability and time-in, below and above range. The measurement of glucose in urine sample is rarely ever used these days and should be reserved for exceptional circumstances. CONCLUSION This review provides a detailed account of various aspects of glucose measurement including their evolution, pitfalls, and their utility in current clinical practice.
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Affiliation(s)
- Suraj Kubihal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Rajesh Khadgawat
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
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31
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Haslund-Thomsen H, Hasselbalch LA, Laugesen B. Parental Experiences of Continuous Glucose Monitoring in Danish Children with Type 1 Diabetes Mellitus. J Pediatr Nurs 2020; 53:e149-e155. [PMID: 32245681 DOI: 10.1016/j.pedn.2020.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To explore parents 'experience of having a child aged 4-9 years with type 1 diabetes mellitus (T1DM) using continuous glucose monitor (CGM). DESIGN AND METHODS The study was a qualitative study. Twelve families were recruited for individual or dyadic interviews through purposeful and convenience sampling procedures. RESULTS Thematic analysis generated three main themes: 1) Living in the context of the unpredictability of diabetes 2) Establishing a sense of control and security with the CGM 3) Learning to use and trust the CGM and educating other caregivers. CONCLUSIONS Living in the context of the unpredictability of T1DM causes a loss of stability and control as T1DM pervades family life and transforms everyday routines. CGM use seems to increase opportunities for other family activities, as it provides parents with a sense of control and moderates the pervasiveness of T1DM. Yet the parents have to learn how to trust and use the CGM and take on the burdensome task of training and trusting other caregivers. PRACTICE IMPLICATIONS The CGM is used as an integral part of T1DM care in everyday life. Therefore, it should be accessible to families. Health-care professionals should be aware of how to assist parents with how to use and trust the CGM. Furthermore, parents may need help and support in educating other caregivers on how to use the CGM. This could be done through teaching sessions, written materials and recorded demonstrations of CGM use.
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Affiliation(s)
- Helle Haslund-Thomsen
- Clinical Nursing research Unit, Aalborg University Hospital, Aalborg, Denmark; Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Aalborg, Denmark; Pediatric Department, Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Aalborg, Denmark.
| | - Line Aagaard Hasselbalch
- Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Aalborg, Denmark; Pediatric Department, Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Aalborg, Denmark
| | - Britt Laugesen
- Clinical Nursing research Unit, Aalborg University Hospital, Aalborg, Denmark; Danish Centre of Clinical Guidelines, Department of Clinical Medicine, Aalborg University, Denmark
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32
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Barbed Ferrández SM, Montaner Gutiérrez T, Larramona Ballarín G, Ferrer Lozano M, Lou Francés GM. Impact on the well-being perceived by caregivers of children and adolescents with type 1 diabetes following the use of interstitial glucose measurement systems. ACTA ACUST UNITED AC 2020; 68:243-250. [PMID: 32113860 DOI: 10.1016/j.endinu.2019.11.007] [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: 10/26/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Type 1 diabetes mellitus (DM-1) is one of the most common chronic childhood diseases, and it is essential to optimize glycemic control in order to avoid complications. For years, interstitial glucose measurement systems (MGI systems) have been among the new technologies at the forefront of self-care. OBJECTIVES To determine the impact on the well-being of the caregivers of patients with type 1 diabetes mellitus under 18 years of age, controlled at a Pediatric Diabetes Unit of a third level hospital, of the use of MGI systems. MATERIAL AND METHODS This was an observational, descriptive and analytical cohort study based on a questionnaire completed by the patients' caregivers, as well as from the patient's clinical history. RESULTS There were 120 participants (55.5% males), with a mean age 13.20+/-3.71 years and mean glycosylated haemoglobin (HbA1c) 7.36%+/-0.90. 52.5% of the sample used MGI systems. The caregivers of patients using MGI systems showed significantly higher scores (p<.05) regarding well-being, compared to the caregivers of patients not using this technology. In the former, a significant improvement (p<.05) in these variables with respect to the values prior to the beginning of their use was observed. CONCLUSIONS The use of MGI systems for diabetes self-management in our study led to a greater sense of well-being on the part of caregivers compared with before their introduction, as well as in comparison with those who continued to perform measurements using daily capillary glycemias.
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Robertson C, Lin A, Smith G, Yeung A, Strauss P, Nicholas J, Davis E, Jones T, Gibson L, Richters J, de Bock M. The Impact of Externally Worn Diabetes Technology on Sexual Behavior and Activity, Body Image, and Anxiety in Type 1 Diabetes. J Diabetes Sci Technol 2020; 14:303-308. [PMID: 31441324 PMCID: PMC7196867 DOI: 10.1177/1932296819870541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aimed to explore the impact of externally worn diabetes technologies on sexual behavior and activity, body image, and anxiety in adopters and nonadopters of these devices. METHODS People with type 1 diabetes aged 16-60 years living in Western Australia were invited to complete an online survey. RESULTS Of the 289 respondents (mean age 34.3 years), 45% used continuous subcutaneous insulin infusion (CSII) and 35% used continuous glucose monitoring (CGM). Approximately half of CSII users stated that the pump interferes with sex. Of these, 75% disconnect their pump during sexual activity to avoid this issue. Comfort during sex influenced the location of the CSII insertion site in 22% of respondents, with the abdomen being preferred. One in four non-CSII users cited sex-related concerns as a factor for not adopting the technology. CGM interfered with sexual activity in 20% of users, but did not commonly affect CGM placement (only 18%). Sexual activity was reported as a factor for not adopting the technology in 10% of non-CGM users. No differences in body dissatisfaction (P = .514) or anxiety (P = .304) between CSII and non-CSII users were observed. No differences in sexual activity and behavior between technology users and nontechnology users were observed. CONCLUSION Wearable technologies impact upon sexual activity and this influences the decision to adopt the technology. Despite this, technology users are similar in terms of sexual behavior, anxiety, and body image compared to nontechnology users. Where appropriate, these data can be used to identify potential concerns, address strategies to mitigate them, and inform people with diabetes when considering adopting external technologies.
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Affiliation(s)
| | | | - Grant Smith
- Telethon Kids Institute, Nedlands,
Australia
| | - Anna Yeung
- Centre for Urban Health Solutions, Li Ka
Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Australian Study of Health and
Relationships, Kirby Institute for Infection and Immunity in Society, University of
New South Wales, Sydney, Australia
| | | | - Jennifer Nicholas
- Perth Children’s Hospital, Nedlands,
Australia
- Telethon Kids Institute, Nedlands,
Australia
- School of Paediatrics and Child Health,
University of Western Australia, Nedlands, Australia
| | - Elizabeth Davis
- Perth Children’s Hospital, Nedlands,
Australia
- Telethon Kids Institute, Nedlands,
Australia
- School of Paediatrics and Child Health,
University of Western Australia, Nedlands, Australia
| | - Tim Jones
- Perth Children’s Hospital, Nedlands,
Australia
- Telethon Kids Institute, Nedlands,
Australia
- School of Paediatrics and Child Health,
University of Western Australia, Nedlands, Australia
| | - Lisa Gibson
- Telethon Kids Institute, Nedlands,
Australia
| | - Juliet Richters
- Australian Study of Health and
Relationships, Kirby Institute for Infection and Immunity in Society, University of
New South Wales, Sydney, Australia
| | - Martin de Bock
- Perth Children’s Hospital, Nedlands,
Australia
- Telethon Kids Institute, Nedlands,
Australia
- School of Paediatrics and Child Health,
University of Western Australia, Nedlands, Australia
- University of Otago and Canterbury
District Health Board, Dunedin, New Zealand
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Liberman A, Barnard-Kelly K. Diabetes Technologies and the Human Factor. Diabetes Technol Ther 2020; 22:S130-S140. [PMID: 32069154 DOI: 10.1089/dia.2020.2510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Alon Liberman
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Petah Tikva, Israel
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35
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Volčanšek Š, Lunder M, Janež A. Acceptability of Continuous Glucose Monitoring in Elderly Diabetes Patients Using Multiple Daily Insulin Injections. Diabetes Technol Ther 2019; 21:566-574. [PMID: 31335199 DOI: 10.1089/dia.2019.0131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Integrative diabetes care is lifelong and encompasses patient-reported outcome measures (PROMs). Understanding older adults' perceptions of continuous glucose monitoring (CGM) benefits and potential annoyances is important to assist with introducing it in this population. The aim of this study was to investigate PROMs and effectiveness of CGM introduction in elderly multiple daily injection (MDI) users with well-controlled diabetes. Methods: MDI-treated elderly (n = 25, mean age 67.6 ± 1.2 years, HbA1c = 7.1% ± 0.2%, 56% type 1 diabetes) were instructed to use a CGM device. PROMs were measured by questionnaires. CGM-recorded glycemic control metrics (time in range [TIR], time in hypoglycemia, coefficient of variation [CV]) were compared during blinded CGM and real-time CGM. Results: Satisfaction with CGM use was high; with perceived advantages as "very common" (4.22 out of 5) and annoyances as "modest" (1.82 out of 5). In total 95% of participants expressed improved sense of security with CGM use, 68% reported of improved sleep quality, and 82% were willing to use a CGM device after finishing the study protocol. CGM introduction did not impose additional diabetes-related distress (measured by the Problem Areas in Diabetes questionnaire). Significant improvements in TIR (3.9-10.0 mmol/L) (66.3% ± 2.6% vs. 76.9% ± 3.0%; P < 0.001), time in hypoglycemia (9.6% ± 2.1% vs. 5.2% ± 1.1%; P = 0.041), as well as reduced glycemic variability (%CV) (37.3 ± 11.1 vs. 32.9 ± 6.3; P < 0.001) were observed. Conclusion: Introduction of CGM in elderly patients with well-controlled diabetes resulted in high satisfaction without imposing additional diabetes distress. Furthermore, an added benefit in glucose control with stabilizing glycemia in target range was proven.
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Affiliation(s)
- Špela Volčanšek
- Clinical Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mojca Lunder
- Clinical Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Andrej Janež
- Clinical Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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Tyndall V, Stimson RH, Zammitt NN, Ritchie SA, McKnight JA, Dover AR, Gibb FW. Marked improvement in HbA 1c following commencement of flash glucose monitoring in people with type 1 diabetes. Diabetologia 2019; 62:1349-1356. [PMID: 31177314 PMCID: PMC6647076 DOI: 10.1007/s00125-019-4894-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/15/2019] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Minimal evidence supports the efficacy of flash monitoring in lowering HbA1c. We sought to assess the impact of introducing flash monitoring in our centre. METHODS We undertook a prospective observational study to assess change in HbA1c in 900 individuals with type 1 diabetes following flash monitoring (comparator group of 518 with no flash monitoring). Secondary outcomes included changes in hypoglycaemia, quality of life, flash monitoring data and hospital admissions. RESULTS Those with baseline HbA1c ≥58 mmol/mol (7.5%) achieved a median -7 mmol/mol (interquartile range [IQR] -13 to -1) (0.6% [-1.2 to -0.1]%) change in HbA1c (p < 0.001). The percentage achieving HbA1c <58 mmol/mol rose from 34.2% to 50.9% (p < 0.001). Median follow-up was 245 days (IQR 182 to 330). Individuals not using flash monitoring experienced no change in HbA1c across a similar timescale (p = 0.508). Higher HbA1c (p < 0.001), younger age at diagnosis (p = 0.003) and lower social deprivation (p = 0.024) were independently associated with an HbA1c fall of ≥5 mmol/mol (0.5%). More symptomatic (OR 1.9, p < 0.001) and asymptomatic (OR 1.4, p < 0.001) hypoglycaemia was reported after flash monitoring. Following flash monitoring, regimen-related and emotional components of the diabetes distress scale improved although the proportion with elevated anxiety (OR 1.2, p = 0.028) and depression (OR 2.0, p < 0.001) scores increased. Blood glucose test strip use fell from 3.8 to 0.6 per day (p < 0.001). Diabetic ketoacidosis admissions fell significantly following flash monitoring (p = 0.043). CONCLUSIONS/INTERPRETATION Flash monitoring is associated with significant improvements in HbA1c and fewer diabetic ketoacidosis admissions. Higher rates of hypoglycaemia may relate to greater recognition of hitherto unrecognised events. Impact upon quality of life parameters was mixed but overall treatment satisfaction was overwhelmingly positive.
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Affiliation(s)
- Victoria Tyndall
- Edinburgh Centre for Endocrinology and Diabetes, Western General Hospital, Edinburgh, UK
| | - Roland H Stimson
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH14 4TJ, UK
| | - Nicola N Zammitt
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Stuart A Ritchie
- Edinburgh Centre for Endocrinology and Diabetes, Western General Hospital, Edinburgh, UK
| | - John A McKnight
- Edinburgh Centre for Endocrinology and Diabetes, Western General Hospital, Edinburgh, UK
| | - Anna R Dover
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH14 4TJ, UK.
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37
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Artificial Pancreas: Current Progress and Future Outlook in the Treatment of Type 1 Diabetes. Drugs 2019; 79:1089-1101. [DOI: 10.1007/s40265-019-01149-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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38
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Sørgård B, Iversen MM, Mårtensson J. Continuous glucose monitoring in adults with type 1 diabetes: A balance between benefits and barriers: A critical incident study. J Clin Nurs 2019; 28:3318-3329. [PMID: 31090960 DOI: 10.1111/jocn.14911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 03/12/2019] [Accepted: 04/14/2019] [Indexed: 01/22/2023]
Abstract
AIMS AND OBJECTIVES To describe positively and negatively perceived situations experienced by adults with type 1 diabetes using continuous glucose monitoring and the actions they take to deal with these situations. BACKGROUND Real-time continuous glucose monitoring has been shown to improve glycaemic control and reduce hypoglycaemia. Although many patients with type 1 diabetes report great benefits when using continuous glucose monitoring, a substantial number discontinue using the device. Little is known about the different situations and experiences with the daily use of continuous glucose monitoring that contribute to such differences. DESIGN A descriptive design based on the critical incident technique was used. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ) (see File S1). METHODS Individual interviews were conducted with a purposive sample of 23 adults with type 1 diabetes, including current and former users of continuous glucose monitoring from four different outpatient clinics. RESULTS The participants described that they felt that the use of continuous glucose monitoring was a balance between benefits and barriers, and how, through their actions, they tried to adapt their use of continuous glucose monitoring to fit their lifestyles. Various life events affected and altered the balance between benefits and barriers and thus affected their use of continuous glucose monitoring. CONCLUSIONS Continuous glucose monitoring is perceived as an effective and important tool in the self-management of diabetes type 1. It enables a better everyday life and increased satisfaction with treatment. At the same time, the use of continuous glucose monitoring can be both demanding and challenging. RELEVANCE TO CLINICAL PRACTICE Understanding the complex interplay between perceived benefits, treatment burden and adherence to continuous glucose monitoring use is important for nurses engaged in diabetes care. Education and support regarding the use of continuous glucose monitoring must be based on the understanding and perspectives of the patient to alleviate stress and barriers and enhance self-efficacy. As the use of continuous glucose monitoring can change over time, this must be a continuous process beyond initial training.
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Affiliation(s)
- Beate Sørgård
- Department of Health and Caring Sciences, Faculty of Health and Social Science, Western University of Applied Sciences, Bergen, Norway.,Department of Medicine, Vestre Viken, Baerum Hospital, Oslo, Norway
| | - Marjolein M Iversen
- Department of Health and Caring Sciences, Faculty of Health and Social Science, Western University of Applied Sciences, Bergen, Norway
| | - Jan Mårtensson
- Department of Health and Caring Sciences, Faculty of Health and Social Science, Western University of Applied Sciences, Bergen, Norway.,Department of Nursing, School of Health and Welfare, Western Norway University of Applied Sciences, Bergen, Norway
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Ajjan R, Slattery D, Wright E. Continuous Glucose Monitoring: A Brief Review for Primary Care Practitioners. Adv Ther 2019; 36:579-596. [PMID: 30659511 PMCID: PMC6824352 DOI: 10.1007/s12325-019-0870-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Indexed: 12/17/2022]
Abstract
Glycated hemoglobin A1c (HbA1c) is routinely used as a marker of average glycemic control, but it fails to provide data on hypoglycemia and glycemic variability, both of which are associated with adverse clinical outcomes. Self-monitoring of blood glucose (SMBG), particularly in insulin-treated patients, is a cornerstone in the management of patients with diabetes. SMBG helps with treatment decisions that aim to reduce high glucose levels while avoiding hypoglycemia and limiting glucose variability. However, repeated SMBG can be inconvenient to patients and difficult to maintain in the long term. By contrast, continuous glucose monitoring (CGM) provides a convenient, comprehensive assessment of blood glucose levels, allowing the identification of high and low glucose levels, in addition to evaluating glycemic variability. CGM using newer detection and visualization systems can overcome many of the limitations of an HbA1c-based approach while addressing the inconvenience and fragmented glucose data associated with SMBG. When used together with HbA1c monitoring, CGM provides complementary information on glucose levels, thus facilitating the optimization of diabetes therapy while reducing the fear and risk of hypoglycemia. Here we review the capabilities and benefits of CGM, including cost-effectiveness data, and discuss the potential limitations of this glucose-monitoring strategy for the management of patients with diabetes. FUNDING: Sanofi US, Inc.
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Affiliation(s)
- Ramzi Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, The LIGHT Laboratories, University of Leeds, Leeds, UK.
| | - David Slattery
- Endocrinology and Metabolic Medicine, York Teaching Hospital, NHS Foundation Trust, York, UK
| | - Eugene Wright
- Department of Medicine and Community and Family Medicine, Duke Southern Regional AHEC, Fayetteville, NC, USA
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40
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Ortiz-Rubio P, Oladunjoye A, Agus MSD, Steil GM. Adjusting Insulin Delivery to Activity (AIDA) clinical trial: Effects of activity-based insulin profiles on glucose control in children with type 1 diabetes. Pediatr Diabetes 2018; 19:1451-1458. [PMID: 30120825 DOI: 10.1111/pedi.12752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/23/2018] [Accepted: 08/07/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Increased daytime activity in children with type I diabetes mellitus (T1DM) is associated with increased risk of hypoglycemia. OBJECTIVE To determine whether an automated weekly review of accelerometer, continuous glucose monitoring (CGM), and insulin pump data, could be used to identify children with increased risk of nighttime hypoglycemia and preemptively adjust the nighttime basal insulin profile according to daytime activity. RESEARCH AND DESIGN METHODS Clinical trial of children with T1DM on insulin pump and CGM therapy. Subjects at risk of nighttime hypoglycemia were identified from regression analysis of daytime step count vs nighttime nadir glucose. If the regression slope was significantly different from zero (P < 0.05) subjects were managed with different algorithm derived nighttime basal insulin profiles following high and low activity days. RESULTS Twenty children (median age: 12; range: 7-17 years) were enrolled. Regression slopes were significant in 10 children. In these children, baseline nighttime nadir glucose level was lower following high activity days (120 [110-139] vs 152 [130-162] mg/dL, P = 0.004). Use of activity-based nighttime basal profiles produced similar nighttime nadir glucose levels following high and low activity days (136 [123-175] vs 140 [108-180] mg/dL, P = 0.73) with fewer nighttime interventions to correct hypoglycemia (0 [0-0.16] vs 0.15 [0.13-0.22] per night, P = 0.008). CONCLUSION Children with lower nighttime glucose levels following high daytime activity can be identified using step count data obtained from readily available accelerometers and the nighttime glucose control improved using different activity-based basal profiles.
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Affiliation(s)
| | - Adeolu Oladunjoye
- Medicine Critical Care, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Michael S D Agus
- Medicine Critical Care, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Garry M Steil
- Medicine Critical Care, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
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41
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Burckhardt MA, Roberts A, Smith GJ, Abraham MB, Davis EA, Jones TW. The Use of Continuous Glucose Monitoring With Remote Monitoring Improves Psychosocial Measures in Parents of Children With Type 1 Diabetes: A Randomized Crossover Trial. Diabetes Care 2018; 41:2641-2643. [PMID: 30377184 DOI: 10.2337/dc18-0938] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 09/12/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to explore the effect of continuous glucose monitors with remote monitoring on psychosocial outcomes in parents of children with type 1 diabetes. RESEARCH DESIGN AND METHODS Children with type 1 diabetes, aged 2-12 years, along with their parents, were studied in a randomized crossover study. They participated in two 3-month periods using conventional blood glucose monitoring (control) or the Dexcom G5 Mobile continuous glucose monitoring (CGM) system with remote monitoring (intervention). The primary outcome was parental fear of hypoglycemia score assessed by the Hypoglycemia Fear Survey. RESULTS Parental Hypoglycemia Fear Survey scores were lower while the child was using CGM with remote monitoring (P < 0.001). Furthermore, parental health-related quality of life and family functioning, stress, anxiety, and sleep measures also improved significantly after intervention. CONCLUSIONS CGM with remote monitoring was found to improve multiple measures of quality of life, reduce family stress, and improve parental sleep.
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Affiliation(s)
- Marie-Anne Burckhardt
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Division of Paediatrics, The University of Western Australia School of Medicine, Perth, Australia
| | - Alison Roberts
- 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
| | - Grant J Smith
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Mary B Abraham
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Division of Paediatrics, The University of Western Australia School of Medicine, Perth, Australia
| | - Elizabeth A Davis
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Division of Paediatrics, The University of Western Australia School of Medicine, Perth, Australia
| | - Timothy W Jones
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia .,Division of Paediatrics, The University of Western Australia School of Medicine, Perth, Australia
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Forlenza GP, Messer LH, Berget C, Wadwa RP, Driscoll KA. Biopsychosocial Factors Associated With Satisfaction and Sustained Use of Artificial Pancreas Technology and Its Components: a Call to the Technology Field. Curr Diab Rep 2018; 18:114. [PMID: 30259309 PMCID: PMC6535227 DOI: 10.1007/s11892-018-1078-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Summarize biopsychosocial factors associated with using continuous glucose monitors (CGMs), insulin pumps, and artificial pancreas (AP) systems and provide a "call to the field" about their importance to technology uptake and maintained use. RECENT FINDINGS Insulin pumps and CGMs are becoming standard of care for individuals with type 1 diabetes (T1D). AP systems combining a CGM, insulin pump, and automated dosing algorithm are available for commercial use. Despite improved glycemic control with AP system use, numerous barriers exist which may limit their benefit. Studies on components of AP systems (pumps, CGMs) are limited and demonstrate mixed results of their impact on fear of hypoglycemia, adherence, quality of life, depression and anxiety, and diabetes distress. Studies examining biopsychological factors associated specifically with sustained use of AP systems are also sparse. Biological, psychological and social impacts of AP systems have been understudied and the information they provide has not been capitalized upon.
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Affiliation(s)
- Gregory P. Forlenza
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
| | - Laurel H. Messer
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
| | - Cari Berget
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
| | - R. Paul Wadwa
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
| | - Kimberly A. Driscoll
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
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43
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Vesco AT, Jedraszko AM, Garza KP, Weissberg-Benchell J. Continuous Glucose Monitoring Associated With Less Diabetes-Specific Emotional Distress and Lower A1c Among Adolescents With Type 1 Diabetes. J Diabetes Sci Technol 2018; 12:792-799. [PMID: 29595061 PMCID: PMC6134305 DOI: 10.1177/1932296818766381] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Psychosocial impact research of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) among adolescents with type 1 diabetes (T1D) is limited. The present study assesses associations between diabetes technology use on adolescent- and parent-perceived diabetes-specific distress and A1c. METHOD Adolescents with T1D and parents (N = 1040; primarily mothers) completed measures of diabetes distress. Adolescents were categorized by technology use: CGM Alone, CSII Alone, CGM+CSII, or No Technology. ANOVA, regression, and Cohen's d were used for group comparisons on measures of diabetes distress and A1c. Analyses also compared groups on clinical elevations of distress. RESULTS CGM use was associated with less adolescent distress compared to No Technology ( d = 0.59), CGM+CSII ( d = 0.26), and CSII Alone ( d = 0.29). Results were similar but with smaller effect size for parent-reported distress, although CGM+CSII showed equivocal association with parent distress compared to No Technology ( d = 0.18). CGM Alone was associated with lower A1c compared to No Technology ( d = 0.48), to CSII Alone ( d = 0.37), and was comparable to CGM+CSII ( d = 0.03). CGM+CSII conferred advantage over CSII Alone ( d = 0.34). Clinical elevation of distress was associated with not using any technology particularly for adolescents. CONCLUSIONS Technology use is associated with lower adolescent distress than lower parent distress. CGM Alone is associated with lower adolescent and parent distress than CSII or CGM+CSII. This appears to be clinically meaningful based on cut scores for measures. CGM is associated with lower A1c independent of being used alone or with CSII.
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Affiliation(s)
- Anthony T. Vesco
- Department of Psychiatry and Behavioral
Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL,
USA
- Anthony T. Vesco, PhD, Ann & Robert H.
Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA.
| | - Aneta M. Jedraszko
- Department of Psychiatry and Behavioral
Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL,
USA
| | - Kimberly P. Garza
- Department of Psychiatry and Behavioral
Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL,
USA
| | - Jill Weissberg-Benchell
- Department of Psychiatry and Behavioral
Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL,
USA
- Northwestern University Feinberg School
of Medicine, Chicago, IL, USA
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44
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Farrington C. Psychosocial impacts of hybrid closed-loop systems in the management of diabetes: a review. Diabet Med 2018; 35:436-449. [PMID: 29247547 DOI: 10.1111/dme.13567] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 12/13/2022]
Abstract
There is a pressing need for new treatment regimens that enable improved glycaemic control and reduced diabetes self-management burdens. Closed-loop, or artificial pancreas, systems represent one of the most promising avenues in this regard. Closed-loop systems connect wearable continuous glucose monitor (CGM) sensors to smartphone- or tablet-mounted algorithms that process and model CGM data to deliver precise and frequently updated doses of fast-acting insulin (and glucagon in dual-hormone systems) to users via wearable pumps. Recent studies have demonstrated that closed-loop systems offer significant benefit in terms of improved glycaemic control. However, less attention has been paid to the psychosocial impact on users of closed-loop systems. This article reviews recent research on psychosocial aspects of closed-loop usage in light of preceding research on user experience of currently available technologies such as insulin pumps and CGM sensors. The small, but growing body of research in this field reports generally positive user experience and a number of experienced benefits including: reassurance and reduced anxiety, improved sleep and confidence, and 'time off' from diabetes demands. However, these benefits are counterbalanced by important challenges, ranging from variable levels of trust to concerns about physical bulk, technical glitches and difficulties incorporating closed-loop systems into everyday life. Future research should explore psychosocial aspects of closed-loop usage in more diverse groups and with regard to clinicians, as well as users, to ensure that the clinical benefits of closed-loop systems are realized at scale in routine medical care.
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Affiliation(s)
- C Farrington
- Cambridge Centre for Health Services Research (CCHSR), Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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