1
|
Knorr S, Aalders J, Overgaard M, Støvring H, Mathiesen ER, Damm P, Clausen TD, Bjerre-Christensen U, Andersen LLT, Vinter C, Kofoed-Enevoldsen A, Lauenborg J, Kampmann U, Fuglsang J, Ovesen PG, Christensen TT, Sørensen A, Ringholm L, Jensen DM. Danish Diabetes Birth Registry 2: a study protocol of a national prospective cohort study to monitor outcomes of pregnancies of women with pre-existing diabetes. BMJ Open 2024; 14:e082237. [PMID: 38670616 PMCID: PMC11057310 DOI: 10.1136/bmjopen-2023-082237] [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: 11/17/2023] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Despite technological developments and intensified care, pregnancies in women with pre-existing diabetes are still considered high-risk pregnancies. The rate of adverse outcomes in pregnancies affected by diabetes in Denmark is currently unknown, and there is a limited understanding of mechanisms contributing to this elevated risk. To address these gaps, the Danish Diabetes Birth Registry 2 (DDBR2) was established. The aims of this registry are to evaluate maternal and fetal-neonatal outcomes based on 5 years cohort data, and to identify pathophysiology and risk factors associated with short-term and long-term outcomes of pregnancies in women with pre-existing diabetes. METHODS AND ANALYSIS The DDBR2 registry is a nationwide 5-year prospective cohort with an inclusion period from February 2023 to February 2028 of pregnancies in women with all types of pre-existing diabetes and includes registry, clinical and questionnaire data and biological samples of mother-partner-child trios. Eligible families (parents age ≥18 years and sufficient proficiency in Danish or English) can participate by either (1) basic level data obtained from medical records (mother and child) and questionnaires (partner) or (2) basic level data and additional data which includes questionnaires (mother and partner) and blood samples (all). The primary maternal outcome is Hemoglobin A1c (HbA1c) levels at the end of pregnancy and the primary offspring endpoint is the birth weight SD score. The DDBR2 registry will be complemented by genetic, epigenetic and metabolomic data as well as a biobank for future research, and the cohort will be followed through data from national databases to illuminate possible mechanisms that link maternal diabetes and other parental factors to a possible increased risk of adverse long-term child outcomes. ETHICS AND DISSEMINATION Approval from the Ethical Committee is obtained (S-20220039). Findings will be sought published in international scientific journals and shared among the participating hospitals and policymakers. TRIAL REGISTRATION NUMBER NCT05678543.
Collapse
Affiliation(s)
- Sine Knorr
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jori Aalders
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin Overgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Syddanmark, Denmark
| | - Henrik Støvring
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tine D Clausen
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Lise Lotte T Andersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Christina Vinter
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | | | - Jeannet Lauenborg
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Ulla Kampmann
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Fuglsang
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus N, Denmark
| | - Per G Ovesen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus N, Denmark
| | - Trine T Christensen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
2
|
Tanenbaum ML, Commissariat PV. Experience with burdens of diabetes device use that affect uptake and optimal use in people with type 1 diabetes. Endocr Connect 2023; 12:e230193. [PMID: 37522857 PMCID: PMC10503226 DOI: 10.1530/ec-23-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/31/2023] [Indexed: 08/01/2023]
Abstract
Diabetes technology continues to advance, with more individuals with type 1 diabetes (T1D) adopting insulin pumps, continuous glucose monitoring (CGM), and automated insulin delivery (AID) systems that integrate real-time glucose data with an algorithm to assist with insulin dosing decisions. These technologies are linked with benefits to glycemic outcomes (e.g. increased time in target range), diabetes management behaviors, and quality of life. However, current devices and systems are not without barriers and hassles for the user. The intent of this review is to describe the personal challenges and reactions that users experience when interacting with current diabetes technologies, which can affect their acceptance and motivation to engage with their devices. This review will discuss user experiences and strategies to address three main areas: (i) the emotional burden of utilizing a wearable device; (ii) the perceived and experienced negative social consequences of device use; and (iii) the practical challenges of wearing devices.
Collapse
Affiliation(s)
- Molly L Tanenbaum
- Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Persis V Commissariat
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Weitgasser R, Ciardi C, Traub J, Barta M, Riedl M, Clodi M, Ludvik B. [Diabetes education and counseling in adult patients with diabetes (Update 2023)]. Wien Klin Wochenschr 2023; 135:137-142. [PMID: 37101034 PMCID: PMC10133358 DOI: 10.1007/s00508-022-02120-0] [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: 11/09/2022] [Indexed: 04/28/2023]
Abstract
Diabetes education and self-management play a critical role in diabetes care. Patient empowerment aims to actively influence the course of the disease by self-monitoring and subsequent treatment modification as well as the ability of patients to integrate diabetes into their daily life and to appropriately adapt diabetes to their life style situation. Diabetes education has to be made accessible for all persons with the disease. In order to be able to provide a structured and validated education program, adequate personnel as well as space, organizational and financial prerequisites are required. Besides an increase in knowledge about the disease it has been shown that a structured diabetes education is able to improve diabetes outcome as measured by parameters, such as blood glucose, HbA1c, lipids, blood pressure and body weight in follow-up evaluations. Modern education programs emphasize the ability of patients to integrate diabetes into everyday life, stress physical activity besides healthy eating as important components of life style therapy and use interactive methods in order to increase the acceptance of personal responsibility. Specific situations (e.g. impaired hypoglycemia awareness, illness, travel), the occurrence of diabetic complications and the use of technical devices such as glucose sensor systems and insulin pumps require additional educational measures supported by adequate electronic tools (diabetes apps and diabetes web portals). New data demonstrate the effect of telemedicine and internet-based services for diabetes prevention and management.
Collapse
Affiliation(s)
- Raimund Weitgasser
- Kompetenzzentrum Diabetes, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich
| | - Christian Ciardi
- Abteilung für Innere Medizin, Krankenhaus St. Vinzenz, Zams, Österreich
| | - Julia Traub
- Ernährungsmedizinischer Dienst, LKH Univ. Klinik Graz, Graz, Österreich
| | - Merlena Barta
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
| | - Michaela Riedl
- Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Martin Clodi
- Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.
- Abteilung für Innere Abteilung, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich.
- ICMR - Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Linz, Österreich.
| | - Bernhard Ludvik
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
| |
Collapse
|
4
|
Pemberton JS, Barrett TG, Dias RP, Kershaw M, Krone R, Uday S. An effective and cost-saving structured education program teaching dynamic glucose management strategies to a socio-economically deprived cohort with type 1 diabetes in a VIRTUAL setting. Pediatr Diabetes 2022; 23:1045-1056. [PMID: 35689452 DOI: 10.1111/pedi.13381] [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: 12/24/2021] [Revised: 05/16/2022] [Accepted: 06/07/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Compare the clinical and cost-effectiveness of an established face to face (F2F) structured education program to a new remote (VIRTUAL) program teaching dynamic glucose management (DynamicGM) to children and young people with type 1 diabetes (CYPD) using continuous glucose monitoring (CGM). To ascertain the most effective DynamicGM strategies predicting time in range (TIR) (3.9-10.0 mmol/L) and incorporating these into a user-friendly teaching aid. DESIGN AND METHODS Effectiveness of the F2F and VIRTUAL programs were ascertained by comparing the mean change (Δ) from baseline to 6 months in HbA1c, TIR and severe hypoglycemia. Delivery cost for the two programs were evaluated. Factors predicting TIR in the combined cohort were determined and incorporated into a user-friendly infographic. RESULTS First 50 graduates per group were evaluated. The mean difference in Δ HbA1c, Δ TIR and Δ episodes of severe hypoglycemia between VIRTUAL and F2F groups were 1.16 (p = 0.47), 0.76 (p = 0.78) and -0.06 (p = 0.61) respectively. Delivery cost per 50 CYPD for VIRTUAL and F2F were $5752 and $7020, respectively. The strongest predictors of TIR (n = 100) were short bursts of exercise (10-40 min) to lower hyperglycemia (p < 0.001), using trend arrow adjustment tools (p < 0.001) and adjusting pre-meal bolus timing based on trend arrows (p < 0.01). These strategies were translated into a GAME (Stop highs), SET (Stay in target), MATCH (Prevent lows) mnemonic. CONCLUSION Teaching DynamicGM VIRTUALLY is just as effective as F2F delivery and cost saving. Short bursts of exercise and using CGM trend arrows to adjust insulin dose and timing improves TIR.
Collapse
Affiliation(s)
- John S Pemberton
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK
| | - Timothy G Barrett
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK.,College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Renuka P Dias
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK.,College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Melanie Kershaw
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK
| | - Ruth Krone
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK
| | - Suma Uday
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK.,College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Affiliation(s)
- Lutz Heinemann
- Science-Consulting in Diabetes GmbH, Kaarst,
Germany
- Lutz Heinemann, PhD, Science-Consulting in Diabetes
GmbH, Geranienweg 7 a, 41564 Kaarst, Germany.
| |
Collapse
|
7
|
Shang T, Zhang JY, Thomas A, Arnold MA, Vetter BN, Heinemann L, Klonoff DC. Products for Monitoring Glucose Levels in the Human Body With Noninvasive Optical, Noninvasive Fluid Sampling, or Minimally Invasive Technologies. J Diabetes Sci Technol 2022; 16:168-214. [PMID: 34120487 PMCID: PMC8721558 DOI: 10.1177/19322968211007212] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Conventional home blood glucose measurements require a sample of blood that is obtained by puncturing the skin at the fingertip. To avoid the pain associated with this procedure, there is high demand for medical products that allow glucose monitoring without blood sampling. In this review article, all such products are presented. METHODS In order to identify such products, four different sources were used: (1) PubMed, (2) Google Patents, (3) Diabetes Technology Meeting Startup Showcase participants, and (4) experts in the field of glucose monitoring. The information obtained were filtered by using two inclusion criteria: (1) regulatory clearance, and/or (2) significant coverage in Google News starting in the year 2016, unless the article indicated that the product had been discontinued. The identified bloodless monitoring products were classified into three categories: (1) noninvasive optical, (2) noninvasive fluid sampling, and (3) minimally invasive devices. RESULTS In total, 28 noninvasive optical, 6 noninvasive fluid sampling, and 31 minimally invasive glucose monitoring products were identified. Subsequently, these products were characterized according to their regulatory, technological, and consumer features. Products with regulatory clearance are described in greater detail according to their advantages and disadvantages, and with design images. CONCLUSIONS Based on favorable technological features, consumer features, and other advantages, several bloodless products are commercially available and promise to enhance diabetes management. Paths for future products are discussed with an emphasis on understanding existing barriers related to both technical and non-technical issues.
Collapse
Affiliation(s)
- Trisha Shang
- Diabetes Technology Society, Burlingame, California, USA
| | | | - Andreas Thomas
- AGDT (Working group of Diabetes Technology), Germany, Ulm, Germany
| | - Mark A. Arnold
- University of Iowa, Department of Chemistry, Iowa City, Iowa, USA
| | | | | | - David C. Klonoff
- Mills-Peninsula Medical Center, San Mateo, California, USA
- David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, Mills-Peninsula Medical Center, 100 South San Mateo Drive, Room 5147, San Mateo, California 94401, USA.
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Ziegler R, Heinemann L, Freckmann G, Schnell O, Hinzmann R, Kulzer B. Intermittent Use of Continuous Glucose Monitoring: Expanding the Clinical Value of CGM. J Diabetes Sci Technol 2021; 15:684-694. [PMID: 32064909 PMCID: PMC8120049 DOI: 10.1177/1932296820905577] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In addition to the continuous use, the intermittent use of continuous glucose monitoring (CGM) is an application of CGM, expanding the typical medical use cases. There are a variety of reasons and occasions that speak in favor of using CGM only for a limited time. To date, these circumstances have not been sufficiently discussed. In this article, we define discontinuous or intermittent CGM use, provide reasons for using it, and expand on the benefits and possibilities of using CGM on a temporary basis. We aim to draw attention to this important topic in the discussion of CGM use and give examples for a different method of CGM use. As well, we would like to foster the allocation of CGM to the right patient groups and indications, especially in cases of limited resources. From a global point of view, intermittent CGM use is more likely to occur than continuous use, primarily for economic reasons.
Collapse
Affiliation(s)
- Ralph Ziegler
- Diabetes Clinic for Children and
Adolescents, Muenster, Germany
- Ralph Ziegler, MD, Diabetes Clinic
for Children and Adolescents Mondstr. 148, Muenster 48155, Germany.
| | | | - Guido Freckmann
- Institut für Diabetes-Technologie,
Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm,
Germany
| | - Oliver Schnell
- Forschergruppe Diabetes e.V.,
Helmholtz Zentrum, Munich, Germany
| | | | - Bernd Kulzer
- Diabetes Center Bad Mergentheim,
Research Institute of the Diabetes Academy, Bad Mergentheim, University
Bamberg, Germany
| |
Collapse
|
10
|
Pemberton JS, Kershaw M, Dias R, Idkowiak J, Mohamed Z, Saraff V, Barrett TG, Krone R, Uday S. DYNAMIC: Dynamic glucose management strategies delivered through a structured education program improves time in range in a socioeconomically deprived cohort of children and young people with type 1 diabetes with a history of hypoglycemia. Pediatr Diabetes 2021; 22:249-260. [PMID: 33205572 DOI: 10.1111/pedi.13155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/28/2020] [Accepted: 11/11/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Create and evaluate the effectiveness of a structured education program in children and young people (CYP) with type 1 diabetes using continuous glucose monitoring (CGM). DESIGN AND METHODS Step 1: CGM devices were evaluated for predetermined criteria using a composite score. Step 2: The education program was developed following review of international structured education guidance, dynamic glucose management (DynamicGM) literature, award-winning diabetes educators' websites, and CGM user feedback. Step 3: Program effectiveness was assessed at six months by change in time below range (TBR) (<3.9mmol/L), time in range (TIR) (3.9-10.0mmol/L), time above range level 2 (TAR2) (>13.9mmol/L), severe hypoglycemia and HbA1c using a paired T-test. A DynamicGM score was developed to assess proactive glucose management. Factors predicting TBR and TIR were assessed using regression analysis. RESULTS Dexcom G6 was chosen for integrated CGM (iCGM) status and highest composite score (29/30). Progressive DynamicGM strategies were taught through five sessions delivered over two months. Fifty CYP (23 male) with a mean (±SD) age and diabetes duration of 10.2 (±4.8) and 5.2 (±3.7) years respectively, who completed the education program were prospectively evaluated. Evaluation at six months showed a significant reduction in TBR (10.4% to 2.1%, p<.001), TAR2 (14.1% to 7.3%, p<.001), HbA1c [7.4 to 7.1% (57.7 to 53.8 mmol/mol), p<.001] and severe hypoglycemic episodes (10 to 1, p<.05); TIR increased (47.4% to 57.0%, p<.001). Number of Dexcom followers (p<.05) predicted reduction in TBR and DynamicGM score (p<.001) predicted increased TIR. CONCLUSION Teaching DynamicGM strategies successfully improves TIR and reduces hypoglycemia.
Collapse
Affiliation(s)
- John S Pemberton
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Melanie Kershaw
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Renuka Dias
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jan Idkowiak
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Zainab Mohamed
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Vrinda Saraff
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Timothy G Barrett
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ruth Krone
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Suma Uday
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
11
|
Schlüter S, Freckmann G, Heinemann L, Wintergerst P, Lange K. Evaluation of the SPECTRUM training programme for real-time continuous glucose monitoring: A real-world multicentre prospective study in 120 adults with type 1 diabetes. Diabet Med 2021; 38:e14467. [PMID: 33230860 DOI: 10.1111/dme.14467] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 12/14/2022]
Abstract
AIMS Comprehensive knowledge, specific skills and data-analysis competences are prerequisites for the successful use of continuous glucose monitoring (CGM) systems. SPECTRUM is a structured training programme for real-time CGM (rtCGM) consisting of a web-based introduction and six group sessions of 90 min each. The 'CGM-TRAIN study' evaluated the efficacy and acceptance of SPECTRUM and rtCGM systems among adults with insulin therapy. METHODS Participants (n = 120) were recruited from 10 German diabetes centres in which they were treated under usual care conditions. Outcome measures were rtCGM knowledge, practical skills, satisfaction with the training programme, satisfaction and acceptance of rtCGM system and glycaemic control. Data were collected at study entry, after training completion and at 6-month follow-up. RESULTS All participants were diagnosed with type 1 diabetes (56% women, mean age 42.4 ± 13.4 years, diabetes duration 21.6 ± 11.6 years), 110 participants completed the course. After training completion, rtCGM-specific knowledge had improved by 43% (scale: 0-40 points) from 21.2 ± 7.6 to 30.4 ± 4.5 points; p < 0.001. The knowledge-level persisted until follow-up (29.4 ± 4.5). Participants were able to master nearly all the practical requirements of the technology. In addition, rtCGM was highly accepted, and participants were motivated to use their systems continuously. HbA1c improved slightly from 61 ± 14 mmol/mol (7.7 ± 1.3%) before training to 60 ± 14 mmol/mol (7.6 ± 1.3%) at follow-up (p = 0.04). The training programme itself was favourably rated by participants. CONCLUSIONS Under usual out-patient daily care conditions, the training programme SPECTRUM improved knowledge and skills about rtCGM in adults with type 1 diabetes. This was associated with a reduced HbA1c , high satisfaction and acceptance of rtCGM (Clinical Trials Registry no.: DRKS00014380).
Collapse
Affiliation(s)
- Sandra Schlüter
- Diabetesschwerpunktpraxis Northeim, Northeim, Germany
- Hannover Medical School - Medical Psychology, Hannover, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | | | - Peter Wintergerst
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Karin Lange
- Hannover Medical School - Medical Psychology, Hannover, Germany
| |
Collapse
|
12
|
Heinemann L, Klonoff DC. An Opportunity to Increase the Benefit of CGM Usage: The Need to Train the Patients Adequately. J Diabetes Sci Technol 2020; 14:983-986. [PMID: 31876181 PMCID: PMC7645144 DOI: 10.1177/1932296819895083] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Lutz Heinemann
- Science & Co, Neuss, Germany
- Lutz Heinemann, PhD, Science Consulting in Diabetes GmbH, Schwerinstr. 50, 41462 Neuss, Germany.
| | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| |
Collapse
|
13
|
Raile K, Boss K, Braune K, Heinrich-Rohr M. Versorgung von Kindern und Jugendlichen mit Typ-1-Diabetes: Lösungen für technische und psychosoziale Herausforderungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:856-863. [DOI: 10.1007/s00103-020-03162-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ZusammenfassungDiabetes mellitus Typ 1 ist die häufigste endokrinologische Erkrankung bei Kindern und Jugendlichen unter 15 Jahren. Eine Heilungsperspektive bezüglich der Autoimmunreaktion gegen die insulinbildenden Betazellen ist weiterhin nicht in Sicht. Dennoch konnte durch technische Innovationsschübe bei Glukosesensoren, Insulinpumpen und Steuerungsalgorithmen innerhalb der letzten Jahre die Stoffwechselkontrolle optimiert werden. Diese Entwicklungen führen zusammen mit individuellen Diabetesschulungen und psychosozialer Unterstützung zu einer deutlichen Verbesserung der Versorgung.In diesem Übersichtsartikel wird die aktuelle Versorgungssituation von Kindern und Jugendlichen mit Typ-1-Diabetes sowie ihren Eltern dargestellt. In Deutschland ist die multidisziplinäre, spezialisierte Versorgung durch Teams aus Kinder- und Jugenddiabetolog*innen, Diabetesberater*innen, Sozialarbeiter*innen und Kinder- und Jugendpsychotherapeut*innen seit vielen Jahren etabliert und führt zu einer im internationalen Vergleich sehr guten Versorgungsqualität. Fokussiert werden die Diabetesschulung mit dem Schwerpunkt, das Selbstmanagement optimal zu unterstützen, die psychosoziale Begleitung und Intervention sowie die Inklusion in Schulen und Kindertagesstätten. Wir gehen außerdem auf neue soziale Entwicklungen der Diabetes-Online-Community ein. Ein aktuelles Beispiel ist die patientenbetriebene Bewegung „Do-It-Yourself Artificial Pancreas System“ (DIY-APS), die als Open-Source-Projekt mittlerweile Innovationsgeber auch für Medizinproduktehersteller ist. Zum Schluss beleuchten wir die damit verbundenen Chancen, aber auch die Verschiebung der klassischen Arzt-Patienten-Rollen.
Collapse
|
14
|
Kordonouri O, Lange K, Biester T, Datz N, Kapitzke K, von dem Berge T, Weiskorn J, Danne T. Determinants of glycaemic outcome in the current practice of care for young people up to 21 years old with type 1 diabetes under real-life conditions. Diabet Med 2020; 37:797-804. [PMID: 31498923 DOI: 10.1111/dme.14130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 02/03/2023]
Abstract
AIM To determine factors influencing the success of treatment for type 1 diabetes, defined as HbA1c < 58 mmol/mol (<7.5%), in a large paediatric cohort under real-life conditions. METHODS This is a monocentric observational study analysing the determinants of glycaemic outcome (sex, age, comorbidities, sociodemographic factors, diabetes technology) in an entire cohort of people with diabetes aged up to 21 years. Glycaemic outcome was defined as an individual's median HbA1c and the prevalence of acute complications over this period. RESULTS Of 700 young people with type 1 diabetes [age 13.6 years (range: 1.4-20.9 years); diabetes duration 5.8 years (range: 0.1-18.3 years)], 63% were using an insulin pump and 32% any type of continuous glucose monitoring. Mean HbA1c was 61 mmol/mol [95% confidence interval (CI) 60-62; 7.7%, 95% CI 7.5-7.8]. Some 63% of children aged < 12 years reached HbA1c (58 mmol/mol (<7.5%) compared with 43% of older participants. The prevalence of severe hypoglycaemia was 2.41 events and that of diabetic ketoacidosis 1.4 events per 100 person-years. Neither type of insulin therapy nor use of continuous glucose monitoring, sex or comorbidity with coeliac disease or thyroiditis was significantly associated with glycaemic outcome. However, age, diabetes duration, having a father not born in Germany, psychiatric comorbidities and family structure were associated with HbA1c . CONCLUSIONS Current technologies and a multidisciplinary team approach allow high numbers of children and adolescents to realize tight glycaemic control with a low prevalence of acute complications. However, age-related challenges, sociodemographic factors and psychological comorbidities are barriers to achieving best possible glycaemic outcome.
Collapse
Affiliation(s)
- O Kordonouri
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - K Lange
- Medical Psychology, Hannover Medical School, Hannover, Germany
| | - T Biester
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - N Datz
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - K Kapitzke
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - T von dem Berge
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - J Weiskorn
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - T Danne
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| |
Collapse
|
15
|
Kubiak T, Priesterroth L, Barnard-Kelly KD. Psychosocial aspects of diabetes technology. Diabet Med 2020; 37:448-454. [PMID: 31943354 DOI: 10.1111/dme.14234] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2020] [Indexed: 12/14/2022]
Abstract
AIM To identify key psychosocial research in the domain of diabetes technology. RESULTS Four trajectories of psychosocial diabetes technology research are identified that characterize research over the past 25 years. Key evidence is reviewed on psychosocial outcomes of technology use as well as psychosocial barriers and facilitating conditions of diabetes technology uptake. Psychosocial interventions that address modifiable barriers and psychosocial factors have proven to be effective in improving glycaemic and self-reported outcomes in diabetes technology users. CONCLUSIONS Psychosocial diabetes technology research is essential for designing interventions and education programmes targeting the person with diabetes to facilitate optimized outcomes associated with technology uptake. Psychosocial aspects of diabetes technology use and related research will be even more important in the future given the advent of systems for automated insulin delivery and the increasingly widespread digitalization of diabetes care.
Collapse
Affiliation(s)
- T Kubiak
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - L Priesterroth
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - K D Barnard-Kelly
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
- BHR Limited, Fareham, UK
| |
Collapse
|
16
|
Abstract
Abstract
Background
For a long time, self-monitoring of blood glucose (SMBG) was widely viewed as the essential glucose measurement procedure in the therapy of insulin-treated people with diabetes. With increasing accuracy and simplified handling of continuous glucose monitoring (CGM) systems, this evolving technology challenges and at least partly replaces SMBG systems.
Content
Sensors of all currently available CGM systems measure glucose levels in the subcutaneous interstitial fluid for 6–14 days. The only available implantable sensor facilitates a measurement span of up to 6 months. Depending on the used system, glucose levels are either shown in real time (rtCGM systems) or after scanning (iscCGM systems). Functions such as alerts, alarms and trend arrows and data presentation encourage independent self-management of diabetes therapy. The high frequency of glucose data and the multitude of existing functions require an extensive training of people with diabetes and their caregivers.
Summary
CGM systems provide a much more detailed picture of glycemia in people with diabetes. Educated patients can use these data to react adequately to their glucose levels and therefore avoid hypoglycemic and hyperglycemic events. Studies showed that glycated hemoglobin (HbA1c) levels and hypoglycemic events can be significantly reduced by frequent use of CGM systems.
Collapse
Affiliation(s)
- Guido Freckmann
- Institut für Diabetes-Technologie , Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm , Lise-Meitner-Str. 8/2, 89081 Ulm , Germany
| |
Collapse
|
17
|
Barnard-Kelly KD, Polonsky WH. Development of a Novel Tool to Support Engagement With Continuous Glucose Monitoring Systems and Optimize Outcomes. J Diabetes Sci Technol 2020; 14:151-154. [PMID: 31113238 PMCID: PMC7189169 DOI: 10.1177/1932296819848686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Increasing numbers of people with diabetes, especially those with type 1 diabetes (T1D), are using continuous glucose monitoring (CGM) systems to support their diabetes self-management, yet even so only approximately 30% of individuals with T1D meet the American Diabetes Association HbA1c target of 58 mmol/mol (7.5%) for children and 53 mmol/mol (7.0%) for adults. We aimed to produce a useful tool for people with diabetes to improve personalized understanding of CGM. METHOD A brief leaflet titled "Guidelines to Improve Glucose Control Using CGM" was developed for people with diabetes. Semistructured interviews were held with 12 adults with T1D, focusing on their views regarding the relevance, readability, and usability of the newly revised leaflet. Participants were specifically asked to share what they would find most useful in terms of information and advice provided as well as how to make use of that in the context of their own diabetes self-management. Data were analyzed thematically and used to inform revisions of the leaflet content. RESULTS Data highlighted information and advice needs as well as personalization in terms of own diabetes management. CONCLUSIONS CGM systems are associated with improved medical and psychosocial outcomes, especially when used effectively to meet the individual needs of the user. Ensuring greater understanding of the individual's expectations when first starting CGM, matching experience and skills to meet those expectations, and tailoring use to the individual needs of each person with diabetes (PWD) are all required to achieve widespread and consistent benefit.
Collapse
Affiliation(s)
- Katharine D. Barnard-Kelly
- Faculty of Health and Social Sciences,
Bournemouth University, Bournemouth, UK
- BHR Limited, Fareham, UK
- Katharine D. Barnard-Kelly, PhD, CPsychol,
AFBPsS, BHR Limited, 42 Kilmiston Dr, Fareham, Hampshire PO16 8EG, UK.
| | | |
Collapse
|
18
|
Heinemann L, Schoemaker M, Schmelzeisen-Redecker G, Hinzmann R, Kassab A, Freckmann G, Reiterer F, Del Re L. Benefits and Limitations of MARD as a Performance Parameter for Continuous Glucose Monitoring in the Interstitial Space. J Diabetes Sci Technol 2020; 14:135-150. [PMID: 31216870 PMCID: PMC7189145 DOI: 10.1177/1932296819855670] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
High-quality performance of medical devices for glucose monitoring is important for a safe and efficient usage of this diagnostic option by patients with diabetes. The mean absolute relative difference (MARD) parameter is used most often to characterize the measurement performance of systems for continuous glucose monitoring (CGM). Calculation of this parameter is relatively easy and comparison of the MARD numbers between different CGM systems appears to be straightforward on the first glance. However, a closer look reveals that a number of complex aspects make interpretation of the MARD numbers provided by the manufacturer for their CGM systems difficult. In this review, these aspects are discussed and considerations are made for a systematic and appropriate evaluation of the MARD in clinical trials. The MARD should not be used as the sole parameter to characterize CGM systems, especially when it comes to nonadjunctive usage of such systems.
Collapse
Affiliation(s)
- Lutz Heinemann
- Science & Co, Neuss, Germany
- Lutz Heinemann, PhD, Science & Co,
Geulenstr 36, 41462 Neuss, Germany.
| | | | | | | | | | - Guido Freckmann
- Institut für Diabetes-Technologie
Forschungs- und Entwicklungsgesellschaft an der Universität Ulm, Ulm, Germany
| | | | | |
Collapse
|
19
|
Weitgasser R, Clodi M, Cvach S, Riedl M, Lechleitner M, Ludvik B. [Diabetes education and counselling in adult patients with diabetes (Update 2019)]. Wien Klin Wochenschr 2019; 131:110-114. [PMID: 30980161 DOI: 10.1007/s00508-019-1449-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Diabetes education and self-management play a critical role in diabetes care. Patient empowerment aims to actively influence the course of the disease by self-monitoring and subsequent treatment modification as well as the ability of patients to integrate diabetes into their daily life and to appropriately adapt it to their life style situation. Diabetes education has to be made accessible for all persons with the disease. In order to be able to provide a structured and validated education program, adequate personnel as well as space, organizational and financial prerequisites are required. Besides an increase in knowledge about the disease it has been shown that a structured diabetes education is able to improve diabetes outcome as measured by parameters, such as blood glucose, HbA1c, blood pressure and body weight in follow-up evaluations. Modern education programs emphasize the ability of patients to integrate diabetes into everyday life, stress physical activity besides healthy eating as important components of life style therapy and use interactive methods in order to increase the acceptance of personal responsibility. Specific situations (e. g. impaired hypoglycemia awareness, illness, travel) and technical innovations, such as glucose sensor systems and insulin pumps require additional educational measures by information exchange in small groups supported by adequate electronic tools (diabetes apps and diabetes web portals).
Collapse
Affiliation(s)
- Raimund Weitgasser
- Abteilung für Innere Medizin, Privatklinik Wehrle-Diakonissen, Guggenbichlerstraße 20, 5026, Salzburg, Österreich.
| | - Martin Clodi
- Abteilung für Innere Abteilung, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
- Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Sarah Cvach
- SKA-Rehabilitationszentrum Alland für Stoffwechselerkrankungen, Alland, Österreich
| | - Michaela Riedl
- Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Monika Lechleitner
- Interne Abteilung, Landeskrankenhaus Hochzirl - Natters, Hochzirl, Österreich
| | - Bernhard Ludvik
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| |
Collapse
|
20
|
Deiss D, Szadkowska A, Gordon D, Mallipedhi A, Schütz-Fuhrmann I, Aguilera E, Ringsell C, De Block C, Irace C. Clinical Practice Recommendations on the Routine Use of Eversense, the First Long-Term Implantable Continuous Glucose Monitoring System. Diabetes Technol Ther 2019; 21:254-264. [PMID: 31021180 PMCID: PMC6532544 DOI: 10.1089/dia.2018.0397] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: The use of real-time continuous glucose monitoring (rtCGM) systems has proved to positively impact the management of type 1 diabetes with the potential to lower HbA1c, reduce frequency and time spent in hypoglycemia, and lower glycemic variability. Nevertheless, the acceptance of rtCGM remains below expectations and the dropout rate within the first year has been reported to be 27%. Besides financial reasons due to limited reimbursement, reasons include the need for frequent sensor replacement, the discomfort of wearing a sensor, the presence of adverse skin reactions, or privacy. Thus, novel approaches to rtCGM are desired to overcome these barriers. The first long-term implantable rtCGM system diversifies the field of glucose monitoring further. However, due to its novelty, there are no published clinical practice guidelines available. Aims: The aim of this article is to set the foundation for a best clinical practice for the everyday clinical care using a long-term implantable CGM system. Methods: An international expert panel for the long-term implantable CGM system developed this best practice guidance. All participants were certified and experienced in the use of the Eversense® long-term implantable CGM system. The workflows from the respective clinics were presented, discussed and are summarized in an ideal care workflow outlined in these practice recommendations. Results: The participants agreed on the following aspects: definition of the patient population that will benefit from a long-term implantable CGM device; real-world experience on safety and accuracy of a long-term CGM; definition of the ideal sensor position; description of the optimal process for sensor insertion, removal, and replacement.
Collapse
Affiliation(s)
- Dorothee Deiss
- Center for Endocrinology and Diabetology, Medicover Berlin-Mitte, Berlin, Germany
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Łódź, Poland
| | - Debbie Gordon
- Center for Diabetes and Endocrinology, Johannesburg, South Africa
- Donald Gordon Medical Centre, WITS (University of the Witwatersrand), Johannesburg, South Africa
| | | | - Ingrid Schütz-Fuhrmann
- Division of Endocrinology, Third Department for Internal Medicine, City-Hospital Hietzing Vienna, Vienna, Austria
| | - Eva Aguilera
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Christophe De Block
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Concetta Irace
- Department of Health Science, University Magna Græcia, Catanzaro, Italy
| |
Collapse
|
21
|
Ziegler R. Analysis of "Performance of a Factory-Calibrated, Real-Time Continuous Glucose Monitoring System in Pediatric Participants With Type 1 Diabetes". J Diabetes Sci Technol 2019; 13:259-260. [PMID: 30453763 PMCID: PMC6399783 DOI: 10.1177/1932296818811672] [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: 11/15/2022]
Abstract
Accuracy of sensors play an important role in the acceptance and long-term use of CGM which is related to improved glycemic outcome. This has been lower in children and adolescents in the past for reasons such as size of the device, pain, and necessity to calibrate sensors but also inaccuracy and perceived nonreliability on alarms among others. In the study of Welsh et al, performance of a new, factory-calibrated sensor was assessed. The accuracy of the sensor, as measured in MARD, paired values within 20/20% or 15/15% and surveillance error grid analysis showed very good results, although less so in low value range <70 mg/dL, falling rate of change, and on first day of use. Accurate glucose measurements especially in these incidences are of utmost importance to people with diabetes as their treatment decisions are based on these, also in the beginning of sensor use.
Collapse
Affiliation(s)
- Ralph Ziegler
- Diabetes Clinic for Children and
Adolescents, Muenster, Germany
- Ralph Ziegler, MD, Diabetes Clinic for
Children and Adolescents, Mondstr.148, 48155 Muenster, Germany.
| |
Collapse
|
22
|
Schiel R, Bambauer R, Steveling A. Technology in Diabetes Treatment: Update and Future. Artif Organs 2018; 42:1017-1027. [PMID: 30334582 DOI: 10.1111/aor.13296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/20/2018] [Accepted: 05/24/2018] [Indexed: 12/14/2022]
Abstract
Worldwide the number of people with diabetes mellitus is increasing. There are estimations that diabetes is one of the leading causes of death. The most important goals for the treatment of diabetes are self-management of the disease and an optimal quality of diabetes control. In the therapy new technologies, like real-time continuous interstitial glucose monitoring, continuous subcutaneous insulin infusion (CSII), electronic tools for the monitoring of therapeutic approaches, automated bolus calculators for insulin and electronic tools for education and information of patients, have become widespread and play important roles. All these efforts are related to the interaction between patients, caregivers, scientists or researchers and industry. The presentation of different aspects of new technological approaches in the present article should give more information about different technologies. However, because of the rather quickly appearance of new technologies, the presentation can only be a spotlight. Further studies are mandatory to analyze the effects and long-term benefits of each technology and electronic device.
Collapse
Affiliation(s)
- Ralf Schiel
- MEDIGREIF-Inselklinik Heringsdorf GmbH, Fachklinik für Kinder und Jugendliche, Ostseebad Heringsdorf, Germany
| | - Rolf Bambauer
- Formely Institute for Blood Purification, Homburg, Germany
| | - Antje Steveling
- Ernst-Moritz-Arndt-University, Internal Medicine A, Greifswald, Germany
| |
Collapse
|
23
|
|
24
|
Petrie JR, Peters AL, Bergenstal RM, Holl RW, Fleming GA, Heinemann L. Improving the Clinical Value and Utility of CGM Systems: Issues and Recommendations: A Joint Statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Diabetes Care 2017; 40:1614-1621. [PMID: 29070577 DOI: 10.2337/dci17-0043] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The first systems for continuous glucose monitoring (CGM) became available over 15 years ago. Many then believed CGM would revolutionize the use of intensive insulin therapy in diabetes; however, progress toward that vision has been gradual. Although increasing, the proportion of individuals using CGM rather than conventional systems for self-monitoring of blood glucose on a daily basis is still low in most parts of the world. Barriers to uptake include cost, measurement reliability (particularly with earlier-generation systems), human factors issues, lack of a standardized format for displaying results, and uncertainty on how best to use CGM data to make therapeutic decisions. This Scientific Statement makes recommendations for systemic improvements in clinical use and regulatory (pre- and postmarketing) handling of CGM devices. The aim is to improve safety and efficacy in order to support the advancement of the technology in achieving its potential to improve quality of life and health outcomes for more people with diabetes.
Collapse
Affiliation(s)
- John R Petrie
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, U.K.
| | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | | | | |
Collapse
|
25
|
Petrie JR, Peters AL, Bergenstal RM, Holl RW, Fleming GA, Heinemann L. Improving the clinical value and utility of CGM systems: issues and recommendations : A joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Diabetologia 2017; 60:2319-2328. [PMID: 29067486 DOI: 10.1007/s00125-017-4463-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 08/23/2017] [Indexed: 01/22/2023]
Abstract
The first systems for continuous glucose monitoring (CGM) became available over 15 years ago. Many then believed CGM would revolutionise the use of intensive insulin therapy in diabetes; however, progress towards that vision has been gradual. Although increasing, the proportion of individuals using CGM rather than conventional systems for self-monitoring of blood glucose on a daily basis is still low in most parts of the world. Barriers to uptake include cost, measurement reliability (particularly with earlier-generation systems), human factors issues, lack of a standardised format for displaying results and uncertainty on how best to use CGM data to make therapeutic decisions. This scientific statement makes recommendations for systemic improvements in clinical use and regulatory (pre- and postmarketing) handling of CGM devices. The aim is to improve safety and efficacy in order to support the advancement of the technology in achieving its potential to improve quality of life and health outcomes for more people with diabetes.
Collapse
Affiliation(s)
- John R Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
| | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | | | | |
Collapse
|
26
|
Affiliation(s)
- Lutz Heinemann
- Science & Co, Düsseldorf, Germany
- Lutz Heinemann, PhD, Science & Co, Kehler Str 24, Düsseldorf, D-40468, Germany.
| |
Collapse
|
27
|
Haviland N, Walsh J, Roberts R, Bailey TS. Update on Clinical Utility of Continuous Glucose Monitoring in Type 1 Diabetes. Curr Diab Rep 2016; 16:115. [PMID: 27718171 DOI: 10.1007/s11892-016-0808-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Since the early 2000s, continuous glucose monitoring (CGM) technology has advanced to become a standard of care in the treatment of type 1 diabetes. Unfortunately, CGM use is not commonly integrated into practice. This article will review the history, technology, and need for systematic training in CGM. Additionally, it will review recent clinical trial data demonstrating the benefits that CGM offers to all people with type 1 diabetes and the clinicians who care for them.
Collapse
Affiliation(s)
- Nalani Haviland
- Advanced Metabolic Care and Research, 625 W. Citracado Pkwy, Ste 108, Escondido, CA, 92025, USA
| | - John Walsh
- Advanced Metabolic Care and Research, 625 W. Citracado Pkwy, Ste 108, Escondido, CA, 92025, USA
| | - Ruth Roberts
- Diabetes Services, Inc., 1030 West Upas St., San Diego, CA, 92103, USA
| | - Timothy S Bailey
- AMCR Institute, 625 West Citracado Parkway Suite 112, Escondido, CA, 92025, USA.
| |
Collapse
|