Real-Time Continuous Glucose Monitoring Facilitates Feelings of Safety in Older Adults With Type 1 Diabetes: A Qualitative Study

Ageing well with diabetes: the role of technology

Over the past two decades there has been a substantial rise in the adoption of diabetes therapeutic technology among children, adolescents and younger adults with type 1 diabetes, and its use is now also advocated for older individuals. Older people with diabetes are more prone to experience hypoglycaemia because of numerous predisposing factors and are at higher risk of hypoglycaemic events requiring third-party assistance as well as other adverse sequelae. Hypoglycaemia may also have long-term consequences, including cognitive impairment, frailty and disability. Diabetes in older people is often characterised by marked glucose variability related to age-associated changes such as variable appetite and levels of physical activity, comorbidities and polypharmacotherapy. Preventing hypoglycaemia and mitigating glucose excursions may have considerable positive impacts on physical and cognitive function and general well-being and may even prevent or improve frailty. Technology for older people includes continuous glucose monitoring systems, insulin pumps, automated insulin delivery systems and smart insulin pens. Clinical trials and real-world studies have shown that older people with diabetes benefit from technology in terms of glucose management, reductions in hypoglycaemic events, emergency department attendance and hospital admissions, and improvement in quality of life. However, ageing may bring physical impairments and other challenges that hinder the use of technology. Healthcare professionals should identify older adults with diabetes who may benefit from therapeutic technology and then adopt an individualised approach to education and follow-up for individuals and their caregivers. Future research should explore the impact of diabetes technology on outcomes relevant to older people with diabetes.

Use of systems thinking and adapted group model building methods to understand patterns of technology use among older adults with type 1 diabetes: a preliminary process evaluation

BACKGROUND

A growing number of older adults (ages 65+) live with Type 1 diabetes. Simultaneously, technologies such as continuous glucose monitoring (CGM) have become standard of care. There is thus a need to understand better the complex dynamics that promote use of CGM (and other care innovations) over time in this age group. Our aim was to adapt methods from systems thinking, specifically a participatory approach to system dynamics modeling called group model building (GMB), to model the complex experiences that may underlie different trajectories of CGM use among this population. Herein, we report on the feasibility, strengths, and limitations of this methodology.

METHODS

We conducted a series of GMB workshops and validation interviews to collect data in the form of questionnaires, diagrams, and recordings of group discussion. Data were integrated into a conceptual diagram of the "system" of factors associated with uptake and use of CGM over time. We evaluate the feasibility of each aspect of the study, including the teaching of systems thinking to older adult participants. We collected participant feedback on positive aspects of their experiences and areas for improvement.

RESULTS

We completed nine GMB workshops with older adults and their caregivers (N = 33). Each three-hour in-person workshop comprised: (1) questionnaires; (2) the GMB session, including both didactic components and structured activities; and (3) a brief focus group discussion. Within the GMB session, individual drawing activities proved to be the most challenging for participants, while group activities and discussion of relevant dynamics over time for illustrative (i.e., realistic but not real) patients yielded rich engagement and sufficient information for system diagramming. Study participants liked the opportunity to share experiences with peers, learning and enhancing their knowledge, peer support, age-specific discussions, the workshop pace and structure, and the systems thinking framework. Participants gave mixed feedback on the workshop duration.

CONCLUSIONS

The study demonstrates preliminary feasibility, acceptability, and the value of GMB for engaging older adults about key determinants of complex health behaviors over time. To our knowledge, few studies have extended participatory systems science methods to older adult stakeholders. Future studies may utilize this methodology to inform novel approaches for supporting health across the lifespan.

Supporting the 'lived expertise' of older adults with type 1 diabetes: An applied focus group analysis to characterize barriers, facilitators, and strategies for self-management in a growing and understudied population

INTRODUCTION

There is a growing number of older adults (≥65 years) who live with type 1 diabetes. We qualitatively explored experiences and perspectives regarding type 1 diabetes self-management and treatment decisions among older adults, focusing on adopting care advances such as continuous glucose monitoring (CGM).

METHODS

Among a clinic-based sample of older adults ≥65 years with type 1 diabetes, we conducted a series of literature and expert informed focus groups with structured discussion activities. Groups were transcribed followed by inductive coding, theme identification, and inference verification. Medical records and surveys added clinical information.

RESULTS

Twenty nine older adults (age 73.4 ± 4.5 years; 86% CGM users) and four caregivers (age 73.3 ± 2.9 years) participated. Participants were 58% female and 82% non-Hispanic White. Analysis revealed themes related to attitudes, behaviours, and experiences, as well as interpersonal and contextual factors that shape self-management and outcomes. These factors and their interactions drive variability in diabetes outcomes and optimal treatment strategies between individuals as well as within individuals over time (i.e. with ageing). Participants proposed strategies to address these factors: regular, holistic needs assessments to match people with effective self-care approaches and adapt them over the lifespan; longitudinal support (e.g., education, tactical help, sharing and validating experiences); tailored education and skills training; and leveraging of caregivers, family, and peers as resources.

CONCLUSIONS

Our study of what influences self-management decisions and technology adoption among older adults with type 1 diabetes underscores the importance of ongoing assessments to address dynamic age-specific needs, as well as individualized multi-faceted support that integrates peers and caregivers.

Continuous glucose monitoring empowers adolescents to take responsibility of diabetes management

BACKGROUND

Managing diabetes is especially challenging for adolescents, and they often struggle to believe they can manage the condition. Illness perception has been widely associated with better diabetes management outcomes, but the influence of continuous glucose monitoring (CGM) on adolescents has been largely neglected.

AIM

The study aimed to explore the illness perception of a group of adolescents living with type 1 diabetes (T1D) using CGM.

SETTING

The study was conducted at a medical centre that provides diabetes care services to youth living with T1D in Parktown, South Africa.

METHODS

A qualitative research approach using semi-structured online interviews was used to gather data that was thematically analysed.

RESULTS

Themes emerging from the data confirmed that CGM creates a sense of control over diabetes management as blood glucose measures were more visible. A sense of normalcy was established as CGM influences a new routine and a way of life, integrating diabetes into a young person's identity. Despite the users' awareness of being different due to diabetes management, CGM assisted in creating a sense of belonging, contributing to developing a better quality of life.

CONCLUSION

Findings of this study support the use of CGM as a means of empowering adolescents struggling with diabetes management to achieve better treatment outcomes. The important role of illness perception in facilitating this change was also evident.Contribution: By listening to the adolescent's voice, CGM was identified as a possible intervention to empower adolescents to improve diabetes management.

"Nothing is linear": Characterizing the determinants and dynamics of CGM use in older adults with type 1 diabetes

AIMS

Continuous glucose monitoring (CGM) can reduce hypoglycemia in older adults with type 1 diabetes (T1D). We aimed to characterize factors that influence effective use in this age group.

METHODS

Older adults with type T1D (age ≥ 65) and their caregivers participated in one of a series of parallel group model building workshops, a participatory approach to system dynamics involving drawing and scripted group activities. Data were synthesized in a qualitative model of the hypothesized system of factors producing distinct patterns of CGM use in older adults. The model was validated through virtual follow-up interviews.

RESULTS

Data were collected from 33 participants (four patient-caregiver dyads, mean age 73.8 ± 4.4 years [range 66-85 years]; 16 % non-CGM users, 79 % pump users). The system model delineates drivers of CGM uptake, drivers of ongoing CGM use, and feedback loops that either reinforce or counteract future CGM use. Participants emphasized the importance of different sets of feedback loops at different points in the duration of CGM use.

CONCLUSIONS

The holistic system model underscores that factors and feedback loops driving effective CGM use in older adults are both individualized and dynamic (e.g., changing over time), suggesting opportunities for staged and tailored age-specific education and support.

Continuous Glucose Monitoring Within Hospital: A Scoping Review and Summary of Guidelines From the Joint British Diabetes Societies for Inpatient Care

Increasing numbers of people, particularly with type 1 diabetes (T1D), are using wearable technologies. That is, continuous subcutaneous insulin infusion (CSII) pumps, continuous glucose monitoring (CGM) systems, and hybrid closed-loop systems, which combine both these elements. Given over a quarter of all people admitted to hospital have diabetes, there is a need for clinical guidelines for when people using them are admitted to hospital. The Joint British Diabetes Societies for Inpatient Care (JBDS-IP) provide a scoping review and summary of guidelines on the use of diabetes technology in people with diabetes admitted to hospital.JBDS-IP advocates enabling people who can self-manage and use their own diabetes technology to continue doing so as they would do out of hospital. Whilst people with diabetes are recommended to achieve a target of 70% time within range (3.9-10.0 mmol/L [70-180 mg/dL]), this can be very difficult to achieve whilst unwell. We therefore recommend targeting hypoglycemia prevention as a priority, keeping time below 3.9 mmol/L (70 mg/dL) at < 1%, being aware of looming hypoglycemia if glucose is between 4.0 and 5.9 mmol/L (72-106 mg/dL), and consider intervening, particularly if there is a downward CGM trend arrow.Health care organizations need clear local policies and guidance to support individuals using diabetes technologies, and ensure the relevant workforce is capable and skilled enough to ensure their safe use within the hospital setting. The current set of guidelines is divided into two parts. Part 1, which follows below, outlines the guidance for use of CGM in hospital. The second part outlines guidance for use of CSII and hybrid closed-loop in hospital.

Barriers and Strategies for Type 1 Diabetes Management Among Emerging Adults: A Qualitative Study

Purpose:

Individuals in the emerging adult age group (18-30 years) with type 1 diabetes (T1DM) have unique medical and social needs. The purpose of this study was to observe barriers and strategies for diabetes management among emerging adults with T1DM.

Methods:

A qualitative grounded theory model was utilized. An open-ended approach with a telephone interview was designed to allow a deeper understanding of the T1DM experience. The participants were from a larger survey-volunteer participant group and were asked to complete 1 interview in spring 2020 (n = 21, diagnosed age: mean 15.00 ± 8.00, females, n = 19). The data were analyzed for cohesive themes using grounded theory.

Results:

Participants indicated three main barrier themes (physiology, environment, and insurance) and 3 barrier subthemes (mental health, lack of social support, and weather). Three main strategy themes to diabetes management were recognized (medical technology, access to social support, and physical activity). There were 2 strategy subthemes (social media and social accountability).

Conclusions:

Regular use of social media can be a key tool for social accountability while lack of social support and physiological shifts can be barriers to management of T1DM. Physical activity should be considered as part of an individualized plan for management of diabetes.

Diabetes Education and Support Tele-Visit Needs Differ in Duration, Content, and Satisfaction in Older Versus Younger Adults

BACKGROUND

Diabetes education and support are critical components of diabetes care. During the COVID-19 pandemic, when telemedicine took the place of in-person visits, remote Certified Diabetes Care and Education Specialist (CDCES) services were offered to address diabetes education and support. Specific needs for older adults, including the time required to provide education and support remotely, have not been previously reported.

METHODS

Adults with diabetes (primarily insulin-requiring) were referred to remote CDCESs. Utilization was individualized based on patient needs and preferences. Topics discussed, patient satisfaction, and time spent in each tele-visit were evaluated by diabetes type, age, sex, insurance type, glycosylated hemoglobin (HbA1c), pump, and continuous glucose monitor (CGM) usage. t-Tests, one-way analysis of variance, and Pearson correlations were employed as appropriate.

RESULTS

Adults (n = 982; mean age 48.4 years, 41.0% age ≥55 years) with type 1 diabetes (n = 846) and type 2 diabetes mellitus (n = 136, 86.0% insulin-treated), 50.8% female; 19.0% Medicaid, 29.1% Medicare, 48.9% private insurance; mean HbA1c 8.4% (standard deviation 1.9); and 46.6% pump and 64.5% CGM users had 2203 tele-visits with remote CDCESs over 5 months. Of those referred, 272 (21.7%) could not be reached or did not receive education/support. Older age (≥55 years), compared with 36-54 year olds and 18-35 year olds, respectively, was associated with more tele-visits (mean 2.6 vs. 2.2 and 1.8) and more time/tele-visits (mean 20.4 min vs. 16.5 min and 14.8 min; p < 0.001) as was coverage with Medicare (mean 2.8 visits) versus private insurance (mean 2.0 visits; p < 0.001) and lower participant satisfaction. The total mean time spent with remote CDCESs was 53.1, 37.4, and 26.2 min for participants aged ≥55, 36-54, and 18-35 years, respectively. During remote tele-visits, the most frequently discussed topics per participant were CGM and insulin pump use (73.4% and 49.7%). After adjustment for sex and diabetes type, older age was associated with lack of access to a computer, tablet, smartphone, or internet (p < 0.001), and need for more education related to CGM (p < 0.001), medications (p = 0.015), hypoglycemia (p = 0.044), and hyperglycemia (p = 0.048).

DISCUSSION

Most remote CDCES tele-visits were successfully completed. Older adults/those with Medicare required more time to fulfill educational needs. Although 85.7% of individual sessions lasted <30 min, which does not meet current Medicare requirements for reimbursement, multiple visits were common with a total time of >50 min for most older participants. This suggests that new reimbursement models are needed. Education/support needs of insulin-treated older adults should be a focus of future studies.

Use of Technology in Older Adults with Type 1 Diabetes: Clinical Characteristics and Glycemic Metrics

Background: The use of diabetes-related technology, both for insulin administration and glucose monitoring, has shown benefits in older adults with type 1 diabetes (T1D). However, the characteristics of older adults with T1D and their use of technology in real-world situations are not well documented. Methods: Older adults (age ≥65 years) with T1D, using insulin pump or multiple daily injections (MDI) for insulin administration, and continuous glucose monitoring (CGM) or glucometer (blood glucose monitoring [BGM]) for glucose monitoring were evaluated. Participants wore CGM for 2 weeks, completed surveys, and underwent laboratory evaluation. Results: We evaluated 165 older adults with T1D; mean age 70 ± 10 years, diabetes duration 40 ± 17 years, and A1C 7.4% ± 0.9% (57 ± 10 mmol/mol). For insulin administration, 63 (38%) were using MDI, while 102 (62%) were using pump. Compared to MDI, pump users were less likely to have cognitive dysfunction (49% vs. 65%, P = 0.04) and had lower scores on the hypoglycemia fear survey (P = 0.03). For glucose monitoring, 95 (58%) used CGM, while 70 (42%) used BGM. Compared to BGM, CGM users were more likely to report impaired awareness of hypoglycemia (IAH) (P = 0.01), and had lower A1C (P = 0.02). Participants who used any technology (pump or CGM) had lower A1C (P = 0.04, 0.006), less hypoglycemia ≤54 mg/dL (P = 0.0006, <0.0001) and <70 mg/dL (P = 0.0002, 0.0001), and fewer glycemic excursions (coefficient of variation %) (P = 0.0001, <0.0001), while reporting more IAH (P = 0.04, P = 0.006) and diabetes distress (P = 0.02, 0.004). Conclusion: Older adults with T1D who use newer diabetes-related technology had better glycemic control, lower hypoglycemia risk, and fewer glycemic excursions. However, they were more likely to report IAH and diabetes-related distress. Clinical trials.gov NCT03078491.

Clinical Considerations for Insulin Therapy in Older Adults with Type 1 Diabetes

Type 1 diabetes represents an autoimmune condition with a strong inherited background, and its incidence is increasing worldwide. About 25% of such cases are diagnosed in adulthood, some even as late as the ninth decade of life. The number of older adults with type 1 diabetes is increasing due to improvements in care and decreased mortality rate. However, there is a lack of clinical trials in people older than 70 years of age with type 1 diabetes complicated with comorbidities, frailty, and dependency. The management of type 1 diabetes and the goals of therapy should be individualized based on the patient's health status and life expectancy. In healthier older adults, insulin treatment regimens (multiple daily insulin injections or insulin pump therapy) that approximate the normal physiology of insulin secretion should be used to achieve lower glycemic goals, while reducing the risk of hypoglycemia with frequent glucose monitoring (preferably using continuous glucose monitoring systems). For frail individuals with poor health, simpler insulin regimens and less stringent glycemic targets would be more appropriate. Poor cognition, vision and hearing, impaired mobility, depression, and chronic pain can interfere with complex insulin regimens. In these individuals, the principal goals of therapy are to reduce the acute effects of hyperglycemia, minimize hypoglycemia risk, and optimize quality of life. The newer insulin preparations and technological advances in insulin delivery and blood glucose monitoring have enhanced the management of type 1 diabetes in all age groups.

Parents' experiences on the combined use of continuous subcutaneous insulin infusion and real-time continuous glucose monitoring to manage Type 1 diabetes in their children: A systematic review and meta-synthesis of qualitative studies

AIM

To explore the experiences and perspectives of the combined use of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) on parents of children with TIDM on their daily life.

DESIGN

A systematic review and meta-synthesis of qualitative studies.

METHODS

A systematic literature search of English studies published in seven databases between 2006-2021: CINAHL, MEDLINE, EMBASE, PubMed, PsycINFO, Cochrane Library and Scopus. All included studies underwent the process of thematic interpretive integration by the author team.

RESULTS

Nine studies met the inclusion criteria. Six derived themes were generated which contained interacting with devices, interacting with glycaemic information, improving quality of life for parents of children with T1DM, burden of living with CSII therapy and CGM, impact on the parent-child relationship, requirement and expectation to advanced diabetes technology. Advanced diabetes technologies affect physical, emotional and relationship between the daily life of parents and their children with T1DM.

Is it possible to constantly and accurately monitor blood sugar levels, in people with Type 1 diabetes, with a discrete device (non-invasive or invasive)?

Real-time continuous glucose monitors using subcutaneous needle-type sensors continue to develop. The limitations of currently available systems, however, include time lag behind changes in blood glucose, the invasive nature of such systems, and in some cases, their accuracy. Non-invasive techniques have been developed, but, to date, no commercial device has been successful. A key research priority for people with Type 1 diabetes identified by the James Lind Alliance was to identify ways of monitoring blood glucose constantly and accurately using a discrete device, invasive or non-invasive. Integration of such a sensor is important in the development of a closed-loop system and the technology must be rapid, selective and acceptable for continuous use by individuals. The present review provides an update on existing continuous glucose-sensing technologies, and an overview of emergent techniques, including their accuracy and limitations.

Benefits and Challenges of Diabetes Technology Use in Older Adults

With successful aging of adults with type 1 diabetes, there is an increased opportunity to use technology for diabetes management. Technology can ease the burden of self-care and provide a sense of security. However, age-related cognitive and physical decline can make technology use difficult. Guidelines using technology in the aging population are urgently needed, along with educational material for the clinicians and caregivers. In this article, we review the evidence supporting the use of diabetes-related technologies in the older population and discuss recommendations based on current data and the authors' clinical knowledge and experience.

RT-CGM in adults with type 1 diabetes improves both glycaemic and patient-reported outcomes, but independent of each other

AIMS

To examine in adults with type 1 diabetes (a) the effect of initiation of real-time continuous glucose monitoring (RT-CGM) on glycaemic and patient-reported outcomes (PROs), and (b) factors related to clinically relevant improvements and sustained device use.

METHODS

60 persons initiating RT-CGM completed questionnaires at device start and six months later. Demographics and clinical characteristics including (dis)continuation up until July 31st 2018 were obtained from medical records.

RESULTS

After six months, 54 adults were still using RT-CGM. Short-term discontinuation (10%) was mainly related to end of pregnancy (wish). Longer-term discontinuation in those with an initial non-pregnancy indication was related to changes in the medical condition and behavioural/psychological reasons. After six months, HbA_1c, diabetes-specific worries and self-efficacy improved (range d = |0.4|-|0.8|), while hypoglycaemia rate or awareness and more general distress did not change. More suboptimal scores at baseline were related to meaningful improvements in HbA_1c (≥10 mmol/mol; 0.9%) and PROs (≥0.5 SD). Changes in glycaemic variables and PROs were not related.

CONCLUSIONS

People with more suboptimal HbA_1c and PRO values appear to benefit most from RT-CGM. Given the lack of association between improvements in medical outcomes and PROs, both should be included in evaluations of RT-CGM therapy on an individual level.

Rationale and protocol for the Assessment of Impact of Real-time Continuous Glucose Monitoring on people presenting with severe Hypoglycaemia (AIR-CGM) study

BACKGROUND

Severe hypoglycaemia carries a significant risk of morbidity and mortality for people with type 1 diabetes. Economic costs are also high, estimated at approximately £13 million annually in England, UK. Continuous glucose monitoring (CGM) has been shown to reduce hypoglycaemia and associated fear, improve overall glycaemia and quality of life, and is cost-effective. Despite effective pathways in place with high levels of resource utilization, it has been reported there are low levels of follow-up, therapy change and specialist intervention after severe hypoglycaemia. This study is designed to assess the impact of providing real-time CGM to people with type 1 diabetes, who have had a recent episode of severe hypoglycaemia (within 72 h), compared to standard care.

METHODS/DESIGN

Fifty-five participants with type 1 diabetes and a recent episode of severe hypoglycaemia, who are CGM naïve, will be recruited to the study. Participants will be randomised to CGM or standard care. The primary outcome is percentage time spent in hypoglycaemia (< 3.0 mmol/L, 55 mg/dL). Secondary outcomes include other measures of hypoglycaemia, time in euglycaemia, overall glucose status and patient reported qualitative measures.

DISCUSSION

This study assesses the impact of providing continuous glucose monitoring at the outset in individuals at highest risk of hypoglycaemia. Changing demand means that novel approaches need to be taken to healthcare provision. This study has the potential to shape future national standards.

TRIAL REGISTRATION

NCT03748433 , November 2018 (UK).

Diabetes Online Community User Perceptions of Successful Aging With Diabetes: Analysis of a #DSMA Tweet Chat

Background

According to the American Diabetes Association, there are approximately 30.3 million Americans with diabetes, and the incidence is growing by nearly 1.5 million cases per year. These individuals are at particularly high risk of developing secondary comorbid conditions related to diabetes and aging. Nearly 45% of individuals aged 65 to 75 years use social media, and this number is steadily growing. The use of social media provides the opportunity to assess the perceptions and needs of this population.

Objective

The purpose of this study was to examine stakeholder perceptions of successful aging with diabetes.

Methods

This study presents a retrospective analysis of a tweet chat focused on aging with diabetes. Tweets were collected using Symplur Signals data analytics software (Symplur LLC) and analyzed for content analysis, sentiment, and participant demographics. Two authors reviewed discussion posts for accuracy of analysis.

Results

A total of 59 individuals participated in this tweet chat generating 494 tweets and nearly 2 million impressions. Most (36/59, 63%) tweet chat participants were people living with diabetes; 25% (14/59) were caregivers and advocates. Seven countries were represented in the conversation. A majority (352/494, 71.3%) of the tweets indicated positive sentiment related to aging with diabetes. Five major themes emerged from the qualitative analysis: (1) personal decline now and in the future, (2) limited access to treatment, (3) inability to provide self-care, (4) health care provider capacity to support aging with diabetes, and (5) life-long online peer health support to facilitate diabetes management.

Conclusions

Individuals with diabetes are living longer and want to be supported with specialized care and access to technology that will allow them to successfully age. Aging- and diabetes-related changes may complicate diabetes management into old age. People with diabetes desire options including aging in place; therefore, special training for care partners and health care providers who care for older adults is needed.

Interference Assessment of Various Endogenous and Exogenous Substances on the Performance of the Eversense Long-Term Implantable Continuous Glucose Monitoring System

BACKGROUND

A variety of prescriptions and over-the-counter medications interfere with transcutaneous continuous glucose monitoring (CGM) sensors. This study characterized the interference profile of the Eversense^® CGM System (Senseonics, Inc., Germantown, MD), which has a different mechanism of glucose detection than other CGM systems.

MATERIALS AND METHODS

Sensor bias (sensor glucose concentration measurement - plasma glucose concentration measured by a reference test) was measured in vitro against 41 different substances at supratherapeutic/supraphysiologic plasma concentrations. Testing was performed using a paired-sample method adapted from the Clinical and Laboratory Standards Institute guidance document EP7-A2. Any substance producing sensor bias that exceeded the International Organization for Standardization (ISO) document 15197:2013 limits was then tested using an in vitro dose-response method to determine whether the concentration producing a significant sensor bias was within physiologic/therapeutic concentration ranges.

RESULTS

Eight of 41 substances produced a sensor bias that exceeded ISO 15197:2013 limits when tested in vitro at supratherapeutic/supraphysiologic plasma concentrations. Only two of these substances (tetracycline and mannitol) exceeded bias limits within therapeutic concentration ranges. Notably, neither acetaminophen nor ascorbic acid, which are substances reported to interfere with other CGM systems, produced sensor bias that exceeded ISO limits when used at physiologic concentrations.

CONCLUSIONS

Although tetracycline and mannitol interfered with the Eversense sensor, substances frequently reported to interfere with enzymatic, electrochemical-based transcutaneous CGM systems, such as acetaminophen and ascorbic acid, did not affect Eversense readings.

Best friend or spy: a qualitative meta-synthesis on the impact of continuous glucose monitoring on life with Type 1 diabetes

AIMS

This is a meta-synthesis of extant qualitative literature related to impact of continuous glucose monitoring (CGM). CGM has been available for a decade for the management of Type 1 diabetes and is the lynchpin of future artificial pancreas technologies. Clinical uptake of CGM is an important area of inquiry. The purpose of this meta-synthesis is to understand the impact of CGM on individuals with Type 1 diabetes and others (parents, significant others, providers) in order to design appropriate clinical interventions for adherence.

METHODS

Studies published in English between 2007 and 2017 were included, reflecting commercial CGM availability. PubMed, PsychINFO, CINALH, Web of Science and EMBASE databases were queried using search terms related to CGM, qualitative, experience and Type 1 diabetes. Included articles contained original qualitative or mixed-method research on CGM, sensor-augmented pump or closed-loop therapies. Articles underwent quality appraisal and thematic interpretive integration by a multidisciplinary team.

RESULTS

Nine articles (343 participants) met the inclusion criteria and were included in the synthesis. Six novel themes emerged: interacting with CGM, burden of living with CGM, feeling different from others, feeling empowered, interacting with glucose information and impact on relationships.

CONCLUSION

CGM affects physical, emotional and relational aspects of life. Clinicians can help minimize the burden of CGM with carefully delivered education and expectation-setting with individuals. Empowerment and relational partnerships in diabetes care can be explored to maximize satisfaction with CGM. Systematic interpretive synthesis of qualitative studies provides a comprehensive, contextual understanding of the impact of CGM on daily life and relationships.

Calibration of Minimally Invasive Continuous Glucose Monitoring Sensors: State-of-The-Art and Current Perspectives

Minimally invasive continuous glucose monitoring (CGM) sensors are wearable medical devices that provide real-time measurement of subcutaneous glucose concentration. This can be of great help in the daily management of diabetes. Most of the commercially available CGM devices have a wire-based sensor, usually placed in the subcutaneous tissue, which measures a "raw" current signal via a glucose-oxidase electrochemical reaction. This electrical signal needs to be translated in real-time to glucose concentration through a calibration process. For such a scope, the first commercialized CGM sensors implemented simple linear regression techniques to fit reference glucose concentration measurements periodically collected by fingerprick. On the one hand, these simple linear techniques required several calibrations per day, with the consequent patient's discomfort. On the other, only a limited accuracy was achieved. This stimulated researchers to propose, over the last decade, more sophisticated algorithms to calibrate CGM sensors, resorting to suitable signal processing, modelling, and machine-learning techniques. This review paper will first contextualize and describe the calibration problem and its implementation in the first generation of CGM sensors, and then present the most recently-proposed calibration algorithms, with a perspective on how these new techniques can influence future CGM products in terms of accuracy improvement and calibration reduction.

A Qualitative Analysis of Real-Time Continuous Glucose Monitoring Data Sharing with Care Partners: To Share or Not to Share?

BACKGROUND

Little research exists regarding how real-time continuous glucose monitoring (RT-CGM) data sharing plays a role in the relationship between patients and their care partners.

OBJECTIVE

To (1) identify the benefits and challenges related to RT-CGM data sharing from the patient and care partner perspective and (2) to explore the number and type of individuals who share and follow RT-CGM data.

METHODS

This qualitative content analysis was conducted by examining publicly available blogs focused on RT-CGM and data sharing. A thematic analysis of blogs and associated comments was conducted.

RESULTS

A systematic appraisal of personal blogs examined 39 blogs with 206 corresponding comments. The results of the study provided insight about the benefits and challenges related to individuals with diabetes sharing their RT-CGM data with a care partner(s). The analysis resulted in three themes: (1) RT-CGM data sharing enhances feelings of safety, (2) the need to communicate boundaries to avoid judgment, and (3) choice about sharing and following RT-CGM data. RT-CGM data sharing occurred within dyads (n = 46), triads (n = 15), and tetrads (n = 2).

CONCLUSIONS

Adults and children with type 1 diabetes and their care partners are empowered by the ability to share and follow RT-CGM data. Our findings suggest that RT-CGM data sharing between an individual with diabetes and their care partner can complicate relationships. Healthcare providers need to engage patients and care partners in discussions about best practices related to RT-CGM sharing and following to avoid frustrations within the relationship.

Wearable Continuous Glucose Monitoring Sensors: A Revolution in Diabetes Treatment

Worldwide, the number of people affected by diabetes is rapidly increasing due to aging populations and sedentary lifestyles, with the prospect of exceeding 500 million cases in 2030, resulting in one of the most challenging socio-health emergencies of the third millennium. Daily management of diabetes by patients relies on the capability of correctly measuring glucose concentration levels in the blood by using suitable sensors. In recent years, glucose monitoring has been revolutionized by the development of Continuous Glucose Monitoring (CGM) sensors, wearable non/minimally-invasive devices that measure glucose concentration by exploiting different physical principles, e.g., glucose-oxidase, fluorescence, or skin dielectric properties, and provide real-time measurements every 1–5 min. CGM opened new challenges in different disciplines, e.g., medicine, physics, electronics, chemistry, ergonomics, data/signal processing, and software development to mention but a few. This paper first makes an overview of wearable CGM sensor technologies, covering both commercial devices and research prototypes. Then, the role of CGM in the actual evolution of decision support systems for diabetes therapy is discussed. Finally, the paper presents new possible horizons for wearable CGM sensor applications and perspectives in terms of big data analytics for personalized and proactive medicine.