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Owusu B, Bivins B, Juste J, Francis L, Itambo J, Akomah J, Yorukoglu N, Gbaba S, Hinneh T, Ajibewa T, Commodore-Mensah Y, Baptiste DL. Continuous glucose monitoring for black older adults with type 2 diabetes mellitus: Challenges, innovations and implications: A discursive review. J Adv Nurs 2024. [PMID: 38924568 DOI: 10.1111/jan.16277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/07/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
AIM To conduct a discursive review on continuous glucose monitoring use among Black older adults and to address the issue of racial disparities in diabetes management and outcomes. Type 2 diabetes mellitus is a global health concern with significant complications and mortality rates. Black older adults are disproportionately affected. Initially designed for type 1 diabetes, continuous glucose monitoring has emerged as an innovative tool for type 2 diabetes mellitus management. Despite its potential, there are challenges related to adherence and digital literacy among Black older adults for managing Diabetes. DESIGN A discursive review. METHODS Searching literature in PubMed, Scopus, and Google Scholar for papers published from 2017 to 2023, we explored the use of continuous glucose monitoring in Black older adults with type 2 diabetes mellitus, examining barriers, facilitators and challenges. DISCUSSION We highlight recommendations from the literature which included barriers, facilitators, and cultural factors associated with continuous glucose monitoring use. Findings underscore the importance of addressing these challenges to reduce racial-ethnic disparities in type 2 diabetes mellitus management among Black older adults. Nurses and advanced practice registered nurses are at the forefront and can play a pivotal role in exploring and implementing interventions to promote access and proper use of continuous glucose monitoring among Black older adult patients with type 2 diabetes mellitus.
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Affiliation(s)
- Brenda Owusu
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Balkys Bivins
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Judith Juste
- College of Arts and Science, University of Miami, Coral Gables, Florida, USA
| | - Lucine Francis
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | | | - Janelle Akomah
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Neslihan Yorukoglu
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Serina Gbaba
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Thomas Hinneh
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Tiwaloluwa Ajibewa
- School of Medicine, Northwestern University Feinberg, Chicago, Illinois, USA
| | | | - Diana-Lyn Baptiste
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Liu Y, Zhang J, Chun X, Gao Y, Yao R, Liang Y, Zhu L, He Y, Huang W. Performance of continuous glucose monitoring in patients with acute respiratory failure: a prospective, single-center observational study. Endocr Pract 2024:S1530-891X(24)00557-3. [PMID: 38876178 DOI: 10.1016/j.eprac.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/23/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE Continuous glucose monitoring (CGM) may have benefits in achieving glycemic control in critically ill patients. The aim of this study was to assess the accuracy of the Freestyle Libre H (professional version of the Libre Pro). in patients with acute respiratory failure (ARF) in the intensive care unit (ICU). METHODS 52 adult patients with ARF were selected. The performance of CGM was evaluated using arterial blood glucose (aBG) and point-of-care (POC) glucose as reference values. Numerical accuracy was evaluated by the mean absolute relative difference (MARD), Bland-Altman analysis, and %15/15(the percentage of CGM values within 15 mg/dL or 15% of reference values <100 mg/dL or >100mg/dL, respectively), %20/20 and %30/30; Clinical accuracy was assessed by Clarke error grid analysis. RESULTS 519 and 1504 pairs of aBG/CGM and POC/CGM glucose values were analyzed. The MARD values were 13.8% and 14.7%, respectively. The mean deviation of the Bland‒Altman analysis was 0.82 mmol/L and 0.81 mmol/L. %15/15, %20/20 and %30/30 of aBG values were 62.6%, 75.5%, and 92.4%, respectively; %15/15, %20/20 and %30/30 of POC values were 57.1%, 72.9%, and 88.7%, respectively. The Clarke error grid analysis showed that 97.8% and 99.3% of the values located in the (A+B) zone. Additionally, accuracy of CGM is not affected by general patient factors. CONCLUSION This study demonstrated that the accuracy of CGM in patients with ARF is lower than that in most outpatients, and it is not affected by general patient factors. Whether CGM is beneficial to glucose management in ICU needs further evaluation.
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Affiliation(s)
- Yanhua Liu
- Department of Emergency Medicine, West China Hospital, Sichuan University / West China School of Nursing / Disaster Medicine Center, Sichuan University, Chengdu, China; Institute of Disaster Medicine, Sichuan University, Chengdu, China; Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Jianna Zhang
- Department of Emergency Medicine, West China Hospital, Sichuan University / West China School of Nursing / Disaster Medicine Center, Sichuan University, Chengdu, China; Institute of Disaster Medicine, Sichuan University, Chengdu, China; Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Xueli Chun
- Center of Gerontology and Geriatrics,West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, China
| | - Yongli Gao
- Department of Emergency Medicine, West China Hospital, Sichuan University / West China School of Nursing / Disaster Medicine Center, Sichuan University, Chengdu, China; Institute of Disaster Medicine, Sichuan University, Chengdu, China; Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Rong Yao
- Department of Emergency Medicine, West China Hospital, Sichuan University / West China School of Nursing / Disaster Medicine Center, Sichuan University, Chengdu, China; Institute of Disaster Medicine, Sichuan University, Chengdu, China; Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Yin Liang
- Department of Emergency Medicine, West China Hospital, Sichuan University / West China School of Nursing / Disaster Medicine Center, Sichuan University, Chengdu, China; Institute of Disaster Medicine, Sichuan University, Chengdu, China; Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Ling Zhu
- Department of Emergency Medicine, West China Hospital, Sichuan University / West China School of Nursing / Disaster Medicine Center, Sichuan University, Chengdu, China; Institute of Disaster Medicine, Sichuan University, Chengdu, China; Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Ying He
- Anesthesia & Operation Center, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, China
| | - Wenxia Huang
- General Practice Medical Center, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, China.
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Sergel-Stringer OT, Wheeler BJ, Styles SE, Boucsein A, Lever CS, Paul RG, Sampson R, Watson A, de Bock MI. Acceptability and experiences of real-time continuous glucose monitoring in adults with type 2 diabetes using insulin: a qualitative study. J Diabetes Metab Disord 2024; 23:1163-1171. [PMID: 38932793 PMCID: PMC11196444 DOI: 10.1007/s40200-024-01403-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/11/2024] [Indexed: 06/28/2024]
Abstract
Aims To explore the lived experiences of initiating real-time continuous glucose monitoring (rt-CGM) use in individuals with type 2 diabetes using insulin. Methods Twelve semi-structured interviews were conducted amongst individuals with type 2 diabetes taking insulin who were enrolled in the 2GO-CGM randomised controlled trial and had completed 3 months of rtCGM. Interviews were transcribed verbatim and analysed to identify common themes regarding their experiences. Results The interviews revealed three key themes: i) rtCGM as a facilitator of improved health behaviours; ii) the acceptability of rtCGM systems compared to capillary blood glucose testing; and iii) barriers to the continual usage of rtCGM technology - including: connection difficulties, longevity of the sensors, and local cutaneous reactions to the sensor adhesive. Conclusion Adults on insulin with type 2 diabetes find rtCGM systems widely acceptable, and easier to engage with than traditional self-monitoring of capillary blood glucose. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-024-01403-9.
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Affiliation(s)
- Oscar T. Sergel-Stringer
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, 201 Great King Street, Dunedin, 9016 Aotearoa New Zealand
- University of Otago, 2 Riccarton Avenue, Christchurch, 8011 Aotearoa New Zealand
| | - Benjamin J. Wheeler
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, 201 Great King Street, Dunedin, 9016 Aotearoa New Zealand
- Department of Paediatrics, Te Whatu Ora Southern, Dunedin, Aotearoa New Zealand
| | - Sara E. Styles
- Department of Human Nutrition, Division of Sciences, University of Otago, 70 Union Street West, Dunedin, 9016 Aotearoa New Zealand
| | - Alisa Boucsein
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, 201 Great King Street, Dunedin, 9016 Aotearoa New Zealand
| | - Claire S. Lever
- Waikato Regional Diabetes Service, Te Whatu Ora, Hamilton, Aotearoa New Zealand
- Te Huataki Waiora, School of Health, University of Waikato, TT Building Hillcrest Road, Hamilton, 3240 Aotearoa New Zealand
- Aotearoa Diabetes Collective, 170 Collingwood Street, Waikato, Hamilton, 3204 Aotearoa New Zealand
| | - Ryan G. Paul
- Waikato Regional Diabetes Service, Te Whatu Ora, Hamilton, Aotearoa New Zealand
- Te Huataki Waiora, School of Health, University of Waikato, TT Building Hillcrest Road, Hamilton, 3240 Aotearoa New Zealand
- Aotearoa Diabetes Collective, 170 Collingwood Street, Waikato, Hamilton, 3204 Aotearoa New Zealand
| | - Rachael Sampson
- Waikato Regional Diabetes Service, Te Whatu Ora, Hamilton, Aotearoa New Zealand
- Aotearoa Diabetes Collective, 170 Collingwood Street, Waikato, Hamilton, 3204 Aotearoa New Zealand
| | - Antony Watson
- Department of Paediatrics, University of Otago, 4 Oxford Terrace, Christchurch, 8024 Aotearoa New Zealand
| | - Martin I. de Bock
- Department of Paediatrics, University of Otago, 4 Oxford Terrace, Christchurch, 8024 Aotearoa New Zealand
- Department of Paediatrics, Te Whatu Ora Waitaha Canterbury, Christchurch, Aotearoa New Zealand
- Department of Paediatrics, University of Otago, Christchurch, 8140 Aotearoa New Zealand
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Cichoń M, Myśliwiec M, Trzeciak M. Role of acrylates in the development of contact dermatitis in diabetic patients-A Polish dermatology tertiary centre experience. Contact Dermatitis 2024; 90:126-133. [PMID: 37840370 DOI: 10.1111/cod.14436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND In recent years, an increasing number of contact dermatitis cases triggered by acrylates contained in diabetes medical devices have been reported. Acrylates seem to play a major role in the development of irritant contact dermatitis and allergic contact dermatitis (ACD) in diabetic patients. OBJECTIVES To study a group of patients with contact dermatitis caused by diabetes medical devices with a focus on acrylates as possible allergens responsible for contact dermatitis. PATIENTS AND METHODS Fifteen patients with diabetes mellitus type 1 and contact dermatitis from diabetic devices were patch tested to 25 acrylate allergens. RESULTS Three patients (20%) reacted to the following allergens: three patients reacted to isobornyl acrylate (IBOA) and one of them additionally to 2-hydroxyethyl acrylate (2-HEA); results were of clinical relevance. All three patients were using insulin pumps and glucose sensors (GS)-in one patient contact dermatitis was towards the insulin pump and the GS, in one patient only towards the insulin pump and in one patient only towards the GS. Twelve patients (80%) did not show any skin reaction towards the allergens tested. CONCLUSION A majority of diabetic patients showed no reactions towards any acrylate allergen tested; yet, the presence of untested allergens must be kept in mind. IBOA proved to be a cause of ACD in diabetes patients. 2-HEA might be another culprit allergen, but its presence in the devices must first be confirmed.
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Affiliation(s)
- Mikołaj Cichoń
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Małgorzata Myśliwiec
- Department of Paediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - Magdalena Trzeciak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 7. Diabetes Technology: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S126-S144. [PMID: 38078575 PMCID: PMC10725813 DOI: 10.2337/dc24-s007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Savoy A, Holden RJ, de Groot M, Clark DO, Sachs GA, Klonoff D, Weiner M. Improving Care for People Living With Dementia and Diabetes: Applying the Human-Centered Design Process to Continuous Glucose Monitoring. J Diabetes Sci Technol 2024; 18:201-206. [PMID: 36384313 PMCID: PMC10899847 DOI: 10.1177/19322968221137907] [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] [Indexed: 11/18/2022]
Abstract
People with Alzheimer's disease or related dementias and diabetes mellitus (ADRD-DM) are at high risk for hypoglycemic events. Their cognitive impairment and psychosocial situation often hinder detection of hypoglycemia. Extending use and benefits of continuous glucose monitoring (CGM) to people with ADRD-DM could improve hypoglycemia detection, inform care, and reduce adverse events. However, cognitive impairment associated with ADRD presents unique challenges for CGM use. This commentary proposes applying the human-centered design process to CGM, investigating design solutions or interventions needed to integrate CGM into the health care of patients with ADRD-DM. With this process, we can identify and inform CGM designs for people with ADRD-DM, broadening CGM access, increasing detection and treatment of the silent threat posed by hypoglycemia.
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Affiliation(s)
- April Savoy
- Purdue School of Engineering & Technology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Richard J. Holden
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel O. Clark
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Greg A. Sachs
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
- Eskenazi Health, Indianapolis, IN, USA
| | - David Klonoff
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
- Dorothy L. and James E. Frank Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | - Michael Weiner
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
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Hamnerius N, Dahlin J, Bruze M, Nilsson K, Sukakul T, Svedman C. Colophonium-related Allergic Contact Dermatitis Caused by Medical Adhesive Tape Used to Prevent Skin Lesions in Soldiers. Acta Derm Venereol 2023; 103:adv18428. [PMID: 38059803 PMCID: PMC10719863 DOI: 10.2340/actadv.v103.18428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/25/2023] [Indexed: 12/08/2023] Open
Abstract
Medical adhesive tapes are commonly recommended for the prevention of friction blisters during hiking and military marches. The aim of this paper is to report on the results of investigations into an outbreak of tape-related foot dermatitis in 26 military conscripts following continuous use of medical adhesive tapes for several days during a field exercise. Patch tests were performed using baseline series and aimed testing was performed with colophonium-related substances and different medical adhesive tapes. Contact allergy to the adhesive tapes used was found in 20 (77%) subjects, and contact allergy to colophonium in 16 (61%). Chemical analysis detected colophonium-related substances in the culprit tapes. Compared with consecutive dermatitis patients investigated at our Department of Occupational and Environmental Dermatology in the previous 10 years, conscripts with colophonium allergy had increased odds ratios for concomitant contact allergy to phenol formaldehyde resins and fragrance substances including hydroperoxides of limonene and linalool. The results show that prolonged use of medical adhesive tapes on intact skin carries a high risk for allergic contact dermatitis. Prior to their introduction on the market, medical devices should be assessed for possible side-effects.
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Affiliation(s)
- Nils Hamnerius
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Jakob Dahlin
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Kristina Nilsson
- Department of Current Operations, Army Command, Swedish Armed Forces, Sweden
| | - Thanisorn Sukakul
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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Jefferies CA, Boucsein A, Styles SE, Chamberlain B, Michaels VR, Crockett HR, De Lange M, Lala A, Cunningham V, Wiltshire EJ, Serlachius AS, Wheeler BJ. Effects of 12-Week Freestyle Libre 2.0 in Children with Type 1 Diabetes and Elevated HbA1c: A Multicenter Randomized Controlled Trial. Diabetes Technol Ther 2023; 25:827-835. [PMID: 37782139 DOI: 10.1089/dia.2023.0292] [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: 10/03/2023]
Abstract
Objective: To investigate whether intermittently scanned continuous glucose monitoring (isCGM) reduced glycated hemoglobin (HbA1c) compared with capillary self-monitored capillary blood glucose (SMBG) in children with type 1 diabetes (T1D) and elevated glycemic control. Research Design and Methods: This multicenter 12-week 1:1 randomized, controlled, parallel-arm trial included 100 participants with established T1D aged 4-13 years (mean 10.9 ± 2.3 years) naive to isCGM and with elevated HbA1c 7.5%-12.2% [58-110 mmol/mol] [mean HbA1c was 9.05 (1.3)%] [75.4 (13.9) mmol/mol]. Participants were allocated to 12-week intervention (isCGM; FreeStyle Libre 2.0; Abbott Diabetes Care, Witney, United Kingdom) (n = 49) or control (SMBG; n = 51). The primary outcome was the difference in change of HbA1c from baseline to 12 weeks. Results: There was no evidence of a difference between groups for change in HbA1c at 12 weeks (0.23 [95% confidence interval; CI: -0.21 to 0.67], P = 0.3). However, glucose-monitoring frequency increased with isCGM +4.89/day (95% CI 2.97-6.81; P < 0.001). Percent time below range (TBR) <3.9 mmol/L (70-180 mg/dL) was reduced with isCGM -6.4% (10.6 to -4.2); P < 0.001. There were no differences in within group changes for Parent or Child scores of psychosocial outcomes at 12 weeks. Conclusions: For children aged 4-13 years with elevated Hba1c isCGM led to improvements in glucose testing frequency and reduced time below range. However, isCGM did not translate into reducing Hba1c or psychosocial outcomes compared to usual care over 12-weeks. The trial is registered within the Australian New Zealand Trial Registry on February 19, 2020 (ACTRN12620000190909p; ANZCTR.org.au) and the World Health Organization International Clinical Trials Registry Platform (Universal Trial Number U1111-1237-0090).
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Affiliation(s)
- Craig A Jefferies
- Starship Child Health, Te Whatu Ora-Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
- Liggins Institute and Department of Paediatrics, The University of Auckland, Auckland, New Zealand
| | - Alisa Boucsein
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Sara E Styles
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Bronte Chamberlain
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
- Department of Pediatrics, Te Whatu Ora Health New Zealand-Southern, Auckland, New Zealand
| | - Venus R Michaels
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
- Department of Pediatrics, Te Whatu Ora Health New Zealand-Southern, Auckland, New Zealand
| | - Hamish R Crockett
- Health, Sport and Human Performance, School of Health, University of Waikato, Hamilton, New Zealand
| | - Michel De Lange
- Pacific Edge Ltd., Centre for Innovation, Dunedin, New Zealand
| | - Anita Lala
- Department of Paediatrics, Te Whatu Ora Health New Zealand-Hauora a Toi, Bay of Plenty, Tauranga, New Zealand
| | - Vicki Cunningham
- Department of Paediatrics, Te Whatu Ora Health New Zealand New Zealand, Te Tai Tokerau, Whangarei, New Zealand
| | - Esko J Wiltshire
- Department of Paediatrics, Te Whatu Ora Health New Zealand-Capital, Coast and Hutt Valley, Wellington, New Zealand
- Department of Paediatrics and Child Health, University of Otago, Wellington, Wellington, New Zealand
| | - Anna S Serlachius
- Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
- Department of Pediatrics, Te Whatu Ora Health New Zealand-Southern, Auckland, New Zealand
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9
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Passanisi S, Berg AK, Chobot A, Dos Santos TJ, Piona CA, Messer L, Lombardo F. First International Survey on Diabetes Providers' Assessment of Skin Reactions in Youth With Type 1 Diabetes Using Technological Devices. J Diabetes Sci Technol 2023:19322968231206155. [PMID: 37846755 DOI: 10.1177/19322968231206155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND Advances in diabetes technological devices led to optimization of diabetes care; however, long-lasting skin exposure to devices may be accompanied by an increasing occurrence of cutaneous reactions. METHODS We used an open-link web-based survey to evaluate diabetes-care providers' viewpoint on prevalence, management practices, and knowledge related to skin reactions with the use of diabetes technological devices. A post hoc analysis was applied to investigate differences in the level of awareness on this topic in relation to the experience in diabetes technology. RESULTS One hundred twenty-five responses from 39 different countries were collected. Most respondents (69%) routinely examine patients' skin at each visit. All the preventive measures are not clear and, mainly, homogenously put into clinical practice. Contact dermatitis was the most frequently reported cutaneous complication due to diabetes devices, and its most common provocative causes are not yet fully known by diabetes-care providers. Almost half of the respondents (42%) had discussed the presence of harmful allergens contained in adhesives with device manufacturers. There is general agreement on the need to strengthen knowledge on dermatological complications. CONCLUSIONS Although diabetes-care providers are quite aware of the chance to develop skin reactions in people with diabetes using technological devices, there are still some unmet needs. Large follow-up studies and further dissemination tools are awaited to address the gaps revealed by our survey.
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Affiliation(s)
- Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Anna Korsgaard Berg
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Agata Chobot
- Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | | | - Claudia Anita Piona
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, Verona, Italy
| | - Laurel Messer
- Barbara Davis Center for Diabetes, University of Colorado Anschutz, Aurora, CO, USA
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
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10
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Genève P, Adam T, Delawoevre A, Jellimann S, Legagneur C, DiPatrizio M, Renard E. High incidence of skin reactions secondary to the use of adhesives in glucose sensors or insulin pumps for the treatment of children with type 1 diabetes. Diabetes Res Clin Pract 2023; 204:110922. [PMID: 37769906 DOI: 10.1016/j.diabres.2023.110922] [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] [Received: 07/25/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
AIMS To evaluate the incidence of the skin reactions secondary to continuous subcutaneous insulin infusion (CSII) or continuous glucose monitoring (CGM), sensors and the characteristics of affected children with type 1 diabetes. METHODS An observational, retrospective, single-centre study included 198 children with type 1 diabetes, (46% girls, mean age 11.75 years). A standardised questionnaire was completed with the patient during current care to evaluate the skin reactions (mean and percentage), the type of reaction, their impact and the treatment) and the characteristics of affected children with univariate and multivariate analysis. RESULTS Sixty-seven children (33.8%) reported active skin reactions: 45 children with CSII (30.4%) and 46 with CGM (23.5%). Children with skin reactions were younger (mean age 10.6 yo versus 12.34 yo, p < 0.05), with a younger age at the diagnosis of diabetes (5.59 yo versus 7.08 yo, p < 0.05). Atopy was more frequent in the group with skin reactions (76.1% versus 54.1% p < 0.05). On multivariate analysis, only the personal history of atopy was associated with skin reactions: OR 2.56 [1.16-5.97] (p < 0.05). CONCLUSION This study confirms the high incidence of skin reactions to adhesive devices used in the treatment of type 1 diabetes in children.
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Affiliation(s)
- P Genève
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - T Adam
- Department of Allergology, Children's Hospital, University Hospital of Nancy, France
| | - A Delawoevre
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - S Jellimann
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - C Legagneur
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - M DiPatrizio
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - E Renard
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France; INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, University of Lorraine, Nancy, France.
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11
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Sehgal S, Elbalshy M, Williman J, Galland B, Crocket H, Hall R, Paul R, Leikis R, de Bock M, Wheeler BJ. The Effect of Do-It-Yourself Real-Time Continuous Glucose Monitoring on Glycemic Variables and Participant-Reported Outcomes in Adults With Type 1 Diabetes: A Randomized Crossover Trial. J Diabetes Sci Technol 2023:19322968231196562. [PMID: 37671754 DOI: 10.1177/19322968231196562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
AIM Real-time continuous glucose monitoring (rtCGM) has several advantages over intermittently scanned continuous glucose monitoring (isCGM) but generally comes at a higher cost. Do-it-yourself rtCGM (DIY-rtCGM) potentially has benefits similar to those of rtCGM. This study compared outcomes in adults with type 1 diabetes using DIY-rtCGM versus isCGM. METHODS In this crossover trial, adults with type 1 diabetes were randomized to use isCGM or DIY-rtCGM for eight weeks before crossover to use the other device for eight weeks, after a four-week washout period where participants reverted back to isCGM. The primary endpoint was time in range (TIR; 3.9-10 mmol/L). Secondary endpoints included other glycemic control measures, psychosocial outcomes, and sleep quality. RESULTS Sixty participants were recruited, and 52 (87%) completed follow-up. Glucose outcomes were similar in the DIY-rtCGM and isCGM groups, including TIR (53.1% vs 51.3%; mean difference -1.7% P = .593), glycosylated hemoglobin (57.0 ± 17.8 vs 61.4 ± 12.2 mmol/L; P = .593), and time in hypoglycemia <3.9 mmol/L (3.9 ± 3.8% vs 3.8 ± 4.0%; P = .947). Hypoglycemia Fear Survey total score (1.17 ± 0.52 vs 0.97 ± 0.54; P = .02) and fear of hypoglycemia score (1.18 ± 0.64 vs 0.97 ± 0.45; P = .02) were significantly higher during DIY-rtCGM versus isCGM. Diabetes Treatment Satisfaction Questionnaire status (DTSQS) score was also higher with DIY-rtCGM versus isCGM (28.7 ± 5.8 vs 26.0 ± 5.8; P = .04), whereas diabetes-related quality of life was slightly lower (DAWN2 Impact of Diabetes score: 3.11 ± 0.4 vs 3.32 ± 0.51; P = .045); sleep quality did not differ between the two groups. CONCLUSION Although the use of DIY-rtCGM did not improve glycemic outcomes compared with isCGM, it positively impacted several patient-reported psychosocial variables. DIY-rtCGM potentially provides an alternative, cost-effective rtCGM option.
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Affiliation(s)
- Shekhar Sehgal
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Mona Elbalshy
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jonathan Williman
- Department of Paediatrics, Canterbury District Health Board, Christchurch, New Zealand
| | - Barbara Galland
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Hamish Crocket
- Te Huataki Waiora School of Health, The University of Waikato, Hamilton, New Zealand
| | - Rosemary Hall
- Te Whatu Ora, Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Ryan Paul
- Te Huataki Waiora School of Health, The University of Waikato, Hamilton, New Zealand
| | | | - Martin de Bock
- Department of Paediatrics, Canterbury District Health Board, Christchurch, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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12
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Lewis DM, Oser TK, Wheeler BJ. Continuous glucose monitoring. BMJ 2023; 380:e072420. [PMID: 36868576 DOI: 10.1136/bmj-2022-072420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Affiliation(s)
| | - Tamara K Oser
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, New Zealand
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13
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Williams TJ, Jeevarathinam AS, Jivan F, Baldock V, Kim P, McShane MJ, Alge DL. Glucose biosensors based on Michael addition crosslinked poly(ethylene glycol) hydrogels with chemo-optical sensing microdomains. J Mater Chem B 2023; 11:1749-1759. [PMID: 36723375 DOI: 10.1039/d2tb02339c] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Continuous glucose monitoring (CGM) devices have the potential to lead to better disease management and improved outcomes in patients with diabetes. Chemo-optical glucose sensors offer a promising, accurate, long-term alternative to the current CGMs that require frequent calibration and replacement. Recently, we have proposed glucose sensor designs using phosphorescence lifetime-based measurement of chemo-optical glucose sensing microdomains embedded within alginate hydrogels. Due to the poor long-term stability of calcium-crosslinked alginate, we propose poly(ethylene glycol) (PEG) hydrogels synthesized via thiol-Michael addition chemistry as an alternative hydrogel carrier. The objective of this study was to evaluate the suitability of Michael addition crosslinked PEG hydrogels compared to calcium crosslinked alginate hydrogels for encapsulating glucose-sensing microdomains. PEG hydrogels crosslinked via thiol-vinyl sulfone addition achieved gelation in under 5 minutes, resulting in an even distribution of sensing microdomains. The shear storage modulus of the PEG hydrogels was tunable from 2.2 ± 0.1 kPa to 9.5 ± 1.8 kPa, which was comparable to the alginate hydrogels (10.5 ± 0.8 kPa), and the inclusion of microdomains did not significantly impact stiffness. The high water content of PEG hydrogels resulted in high glucose permeability that closely corresponded to the glucose permeability of alginate (D = 0.09 and 0.12 cm2 s-1, respectively; p = 0.47), but the PEG hydrogels exhibited superior stability. Both PEG and alginate-embedded sensors exhibited a sensing range up to ∼200 mg dL-1 glucose. The lower limits of detection (LOD) for PEG and alginate-based glucose sensors were 19.8 and 20.6 mg dL-1 with a difference of just 4.2% variation. The small difference between PEG and alginate embedded sensors indicates that their sensing properties are primarily determined by the glucose sensing microdomains rather than the hydrogel matrix. Overall, the results of this study indicate that Michael addition-crosslinked PEG hydrogels are a promising platform for encapsulation of chemo-optical glucose sensing microdomains.
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Affiliation(s)
- Tyrell J Williams
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA.
| | | | - Faraz Jivan
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA.
| | - Victoria Baldock
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA.
| | - Paul Kim
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA.
| | - Michael J McShane
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA. .,Department of Materials Science and Engineering, Texas A&M University, College Station, Texas, USA
| | - Daniel L Alge
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA. .,Department of Materials Science and Engineering, Texas A&M University, College Station, Texas, USA
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14
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Rimskaya AM, Krasnovidova AE, Vitebskaya AV. Practicalities of Flash-monitoring systems utilization in the questionnaire survey of children and adolescents with type 1 diabetes mellitus. DIABETES MELLITUS 2023. [DOI: 10.14341/dm12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND: Children and adolescents with type 1 diabetes mellitus (T1DM) are recommended to perform self-control 6–10 times a day to maintain optimal blood glucose levels. Currently, there are various devices, such as glucometers, systems for continuous blood glucose monitoring and flash monitoring (FMS). In real clinical practice patients can combine the use of various devices and face with problems of their exploitation.AIM: To investigate the peculiarities of FMS utilization by children and adolescents with T1DM using questionnaire survey.MATERIALS AND METHODS: From 06.2020 till 05.2021, a survey of patients with T1DM was conducted as part of a single-center, observational, one-stage, uncontrolled study. The questionnaire contained questions regarding the number of measurements, circumstances and adverse reactions when using the devices.RESULTS: We questioned 80 patients (47 girls and 33 boys) aged 11.7 (9.0; 14.0) years with DM1 for 4.9 (2.0; 7.0) years, HbA1c level 8.2 (6.8; 9.0)) which were in pediatric endocrinology department of the University Children’s Clinical Hospital.The majority of patients (86.3%) scan the sensor more than 10 times a day; 25% of FMS-users measure blood glucose with glucometer not every day.The majority of patients (51,3%) prefer to use FMS instead of glucometer in all circumstances. Patients face with errors using FMS more often than using glucometers — OR 3.4 (95% CI 1.7–6.8). Non-significant reaction to adhesive material disturbed 50.0% participants; one patient (1.3%) had to refuse FMS due to allergic reaction.Among possible reasons to refuse FMS patients often name error, skin sealing, high price, inflammation, inconvenience to wear a device.Additional measures for fixing FMS device are always used by 36,3% of patients, sometimes — 18,8%, in some situations (going in for sports, swimming, travelling, in case of unsticking at the end of term) — 15,0%.CONCLUSION: Quarter of FMS users double-check glycaemia values rarer than recommended. Patients face with error using FMS more often than using glucometer. Local reaction to adhesive material does not influence FMS utilization. The majority of patients use additional measures for fixing FMS devices.
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15
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA. 7. Diabetes Technology: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S111-S127. [PMID: 36507635 PMCID: PMC9810474 DOI: 10.2337/dc23-s007] [Citation(s) in RCA: 116] [Impact Index Per Article: 116.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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16
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Sherr JL, Heinemann L, Fleming GA, Bergenstal RM, Bruttomesso D, Hanaire H, Holl RW, Petrie JR, Peters AL, Evans M. Automated insulin delivery: benefits, challenges, and recommendations. A Consensus Report of the Joint Diabetes Technology Working Group of the European Association for the Study of Diabetes and the American Diabetes Association. Diabetologia 2023; 66:3-22. [PMID: 36198829 PMCID: PMC9534591 DOI: 10.1007/s00125-022-05744-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/07/2022] [Indexed: 01/15/2023]
Abstract
A technological solution for the management of diabetes in people who require intensive insulin therapy has been sought for decades. The last 10 years have seen substantial growth in devices that can be integrated into clinical care. Driven by the availability of reliable systems for continuous glucose monitoring, we have entered an era in which insulin delivery through insulin pumps can be modulated based on sensor glucose data. Over the past few years, regulatory approval of the first automated insulin delivery (AID) systems has been granted, and these systems have been adopted into clinical care. Additionally, a community of people living with type 1 diabetes has created its own systems using a do-it-yourself approach by using products commercialised for independent use. With several AID systems in development, some of which are anticipated to be granted regulatory approval in the near future, the joint Diabetes Technology Working Group of the European Association for the Study of Diabetes and the American Diabetes Association has created this consensus report. We provide a review of the current landscape of AID systems, with a particular focus on their safety. We conclude with a series of recommended targeted actions. This is the fourth in a series of reports issued by this working group. The working group was jointly commissioned by the executives of both organisations to write the first statement on insulin pumps, which was published in 2015. The original authoring group was comprised by three nominated members of the American Diabetes Association and three nominated members of the European Association for the Study of Diabetes. Additional authors have been added to the group to increase diversity and range of expertise. Each organisation has provided a similar internal review process for each manuscript prior to submission for editorial review by the two journals. Harmonisation of editorial and substantial modifications has occurred at both levels. The members of the group have selected the subject of each statement and submitted the selection to both organisations for confirmation.
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Affiliation(s)
| | | | | | - Richard M Bergenstal
- International Diabetes Center and HealthPartners Institute, Minneapolis, MN, USA
| | - Daniela Bruttomesso
- Unit of Metabolic Diseases, Department of Medicine, University of Padova, Padova, Italy
| | - Hélène Hanaire
- Department of Diabetology, University Hospital of Toulouse, University of Toulouse, Toulouse, France
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute of Biomedical Engineering (ZIBMT), University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Mark Evans
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
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17
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Williams ME, Steenkamp D, Wolpert H. Making sense of glucose sensors in end-stage kidney disease: A review. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:1025328. [PMID: 36992784 PMCID: PMC10012164 DOI: 10.3389/fcdhc.2022.1025328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
Diabetes mellitus remains the leading cause of end-stage kidney disease worldwide. Inadequate glucose monitoring has been identified as one of the gaps in care for hemodialysis patients with diabetes, and lack of reliable methods to assess glycemia has contributed to uncertainty regarding the benefit of glycemic control in these individuals. Hemoglobin A1c, the standard metric to evaluate glycemic control, is inaccurate in patients with kidney failure, and does not capture the full range of glucose values for patients with diabetes. Recent advances in continuous glucose monitoring have established this technology as the new gold standard for glucose management in diabetes. Glucose fluctuations are uniquely challenging in patients dependent on intermittent hemodialysis, and lead to clinically significant glycemic variability. This review evaluates continuous glucose monitoring technology, its validity in the setting of kidney failure, and interpretation of glucose monitoring results for the nephrologist. Continuous glucose monitoring targets for patients on dialysis have yet to be established. While continuous glucose monitoring provides a more complete picture of the glycemic profile than hemoglobin A1c and can mitigate high-risk hypoglycemia and hyperglycemia in the context of the hemodialysis procedure itself, whether the technology can improve clinical outcomes merits further investigation.
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Affiliation(s)
- Mark E. Williams
- Renal Unit, Joslin Diabetes Center, Boston MA, United States
- *Correspondence: Mark E. Williams,
| | - Devin Steenkamp
- Section of Endocrinology, Diabetes, and Nutrition, Department of Medicine, Boston Medical Center, Boston, MA, United States
| | - Howard Wolpert
- Boston University School of Medicine, Boston, MA, United States
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18
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de Bock M, Codner E, Craig ME, Huynh T, Maahs DM, Mahmud FH, Marcovecchio L, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes. Pediatr Diabetes 2022; 23:1270-1276. [PMID: 36537523 PMCID: PMC10107615 DOI: 10.1111/pedi.13455] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Ethel Codner
- Institute of Maternal and Child Research (IDMI), School of Medicine, Universidad de Chile, Santiago, Chile
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia.,Discipline of Paediatrics & Child Health, School of Clinical Medicine, University of New South Wales Medicine & Health, Sydney, Australia
| | - Tony Huynh
- Department of Endocrinology & Diabetes, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Department of Chemical Pathology, Mater Pathology, South Brisbane, Queensland, Australia.,School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David M Maahs
- Department of Pediatrics, Division of Endocrinology, Lucile Salter Packard Children's Hospital, Stanford University, Stanford, California, USA.,Stanford Diabetes Research Center, Stanford University, Stanford, California, USA.,Department of Epidemiology, Stanford University, Stanford, California, USA
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Linda A DiMeglio
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
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19
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Sherr JL, Heinemann L, Fleming GA, Bergenstal RM, Bruttomesso D, Hanaire H, Holl RW, Petrie JR, Peters AL, Evans M. Automated Insulin Delivery: Benefits, Challenges, and Recommendations. A Consensus Report of the Joint Diabetes Technology Working Group of the European Association for the Study of Diabetes and the American Diabetes Association. Diabetes Care 2022; 45:3058-3074. [PMID: 36202061 DOI: 10.2337/dci22-0018] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/07/2022] [Indexed: 02/03/2023]
Abstract
A technological solution for the management of diabetes in people who require intensive insulin therapy has been sought for decades. The last 10 years have seen substantial growth in devices that can be integrated into clinical care. Driven by the availability of reliable systems for continuous glucose monitoring, we have entered an era in which insulin delivery through insulin pumps can be modulated based on sensor glucose data. Over the past few years, regulatory approval of the first automated insulin delivery (AID) systems has been granted, and these systems have been adopted into clinical care. Additionally, a community of people living with type 1 diabetes has created its own systems using a do-it-yourself approach by using products commercialized for independent use. With several AID systems in development, some of which are anticipated to be granted regulatory approval in the near future, the joint Diabetes Technology Working Group of the European Association for the Study of Diabetes and the American Diabetes Association has created this consensus report. We provide a review of the current landscape of AID systems, with a particular focus on their safety. We conclude with a series of recommended targeted actions. This is the fourth in a series of reports issued by this working group. The working group was jointly commissioned by the executives of both organizations to write the first statement on insulin pumps, which was published in 2015. The original authoring group was comprised by three nominated members of the American Diabetes Association and three nominated members of the European Association for the Study of Diabetes. Additional authors have been added to the group to increase diversity and range of expertise. Each organization has provided a similar internal review process for each manuscript prior to submission for editorial review by the two journals. Harmonization of editorial and substantial modifications has occurred at both levels. The members of the group have selected the subject of each statement and submitted the selection to both organizations for confirmation.
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Affiliation(s)
| | | | | | | | - Daniela Bruttomesso
- Unit of Metabolic Diseases, Department of Medicine, University of Padova, Padova, Italy
| | - Hélène Hanaire
- Department of Diabetology, University Hospital of Toulouse, University of Toulouse, Toulouse, France
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute of Biomedical Engineering (ZIBMT), University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Mark Evans
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
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20
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Tauschmann M, Forlenza G, Hood K, Cardona-Hernandez R, Giani E, Hendrieckx C, DeSalvo DJ, Laffel LM, Saboo B, Wheeler BJ, Laptev DN, Yarhere I, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Glucose monitoring. Pediatr Diabetes 2022; 23:1390-1405. [PMID: 36537528 PMCID: PMC10107687 DOI: 10.1111/pedi.13451] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Martin Tauschmann
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gregory Forlenza
- Pediatric Diabetes Division, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Korey Hood
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Elisa Giani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia Victoria, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Daniel J DeSalvo
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Lori M Laffel
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, Massachusetts, USA.,Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Banshi Saboo
- Department of Diabetology, Diabetes Care and Hormone Clinic, Ambawadi, Ahmedabad, Gujarat, India
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,Paediatrics Department, Southern District Health Board, Dunedin, New Zealand
| | | | - Iroro Yarhere
- Endocrinology Unit, Paediatrics Department, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
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21
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Fröhlich-Reiterer E, Elbarbary NS, Simmons K, Buckingham B, Humayun KN, Johannsen J, Holl RW, Betz S, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes 2022; 23:1451-1467. [PMID: 36537532 DOI: 10.1111/pedi.13445] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Kimber Simmons
- Barbara Davis Center for Diabetes, University of Colorado, Denver, Colorado, USA
| | - Bruce Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University Medical Center, Stanford, California, USA
| | - Khadija N Humayun
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jesper Johannsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev and Steno Diabetes Center Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Shana Betz
- Parent/Advocate for people with diabetes, Markham, Canada
| | - Farid H Mahmud
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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22
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Raison-Peyron N, Mowitz M, Dereure O, Svedman C. Allergic Contact Dermatitis in a Patient After Five Years of Use of Omnipod Insulin Pump. J Diabetes Sci Technol 2022; 16:1342-1343. [PMID: 36048581 PMCID: PMC9445354 DOI: 10.1177/19322968221110578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nadia Raison-Peyron
- Department of Dermatology, Hôpital Saint Eloi, Montpellier University Hospital, Montpellier University, Montpellier, France
- Nadia Raison-Peyron, MD, Department of Dermatology, Hôpital Saint Eloi, Montpellier University Hospital, Montpellier University, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France.
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Olivier Dereure
- Department of Dermatology, Hôpital Saint Eloi, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, University of Lund, Malmö, Sweden
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23
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Contact Dermatitis in the Inpatient Hospital Setting–an Updated Review of the Literature. CURRENT DERMATOLOGY REPORTS 2022. [DOI: 10.1007/s13671-022-00366-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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24
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Watson A. Flash glucose sensing: understanding the benefits and risks to facilitate patient engagement. PRACTICAL DIABETES 2022. [DOI: 10.1002/pdi.2411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Alastair Watson
- Clinical and Experimental Sciences University of Southampton Faculty of Medicine UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton UK
- University of Birmingham Medical School Birmingham UK
- University of Cambridge Cambridge UK
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25
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Kompala T, Neinstein AB. Analysis of "Accuracy of a 14-Day Factory Calibrated Continuous Glucose Monitoring System With Advanced Algorithm in Pediatric and Adult Population With Diabetes". J Diabetes Sci Technol 2022; 16:78-80. [PMID: 33084373 PMCID: PMC8875038 DOI: 10.1177/1932296820967004] [Citation(s) in RCA: 1] [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: 11/15/2022]
Abstract
In this study by Alva et al, accuracy of a second-generation factory calibrated continuous glucose monitoring system is evaluated. Compared to the first-generation FreeStyle Libre 14-day system (FSL), accuracy was improved throughout the 14-day wear period, including improved accuracy in hypoglycemia for adults and youth. The addition of optional real-time alerts for hypoglycemia and hyperglycemia as well as an integrated continuous glucose monitor (iCGM) designation by the FDA may further enable users to benefit from using CGM in real time, including in future automated insulin delivery systems. As CGM accuracy, affordability, and accessibility improve, we anticipate increased uptake of CGM by people on intensive insulin therapy, and also potential benefits and expansion into a broader patient population. There are growing opportunities to leverage cloud-connected CGM devices in the increasingly virtual, continuous telehealth-driven diabetes care model, which will require more focus on development and use of data interoperability standards.
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Affiliation(s)
- Tejaswi Kompala
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Aaron B. Neinstein
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA
- Aaron B. Neinstein, MD, University of California, San Francisco, 1700 Owens Street, Suite 541, San Francisco, CA 94158, USA.
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27
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Affiliation(s)
- Arthur L.M. Swislocki
- Medical Service, Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA
- Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, CA
- Corresponding author: Arthur L.M. Swislocki,
| | | | - Joseph J. Ravera
- Division of Emergency Medicine, Department of Surgery, University of Vermont Medical Center, Burlington, VT
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
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Lombardo F, Passanisi S, Tinti D, Messina MF, Salzano G, Rabbone I. High Frequency of Dermatological Complications in Children and Adolescents with Type 1 Diabetes: A Web-Based Survey. J Diabetes Sci Technol 2021; 15:1377-1381. [PMID: 32757778 PMCID: PMC8655296 DOI: 10.1177/1932296820947072] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Despite advances in the management of type 1 diabetes (T1D), there is an increasing incidence of skin reactions related to diabetes devices such as patch pumps and glucose sensors. Aim of the present study was to assess the prevalence of dermatological complications in pediatric patients with T1D using technological devices. METHODS Online survey regarding skin reactions related to the use of patch pumps and/or glucose sensors was administered to families of children and adolescents (0-17 years) with T1D. Data were collected on demographic characteristics, duration of diabetes, and clinical features of dermatological complications if present. RESULTS Our study population consisted of 139 patients (female 51.8%) aged 11.1 ± 3.3 years. More than half (51.1%) experienced skin reactions due to patch pumps or glucose sensors. Dermatological complications were mainly caused by continuous glucose monitoring (56.3% of total). Timing of appearance of dermatological reactions varied from a few days to several months after the introduction of the device. The application of hypoallergenic barrier bandages was the most frequently adopted measure to solve the issue. CONCLUSIONS Our study confirmed high frequency of dermatological complications among pediatric patients with type 1 diabetes. Well-designed studies are awaited to provide clear recommendations to minimize the burden of skin issues related to technological devices.
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Affiliation(s)
- Fortunato Lombardo
- Department of Human Pathology in Adult
and Developmental Age, University of Messina, Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult
and Developmental Age, University of Messina, Messina, Italy
- Stefano Passanisi, Department of Human
Pathology in Adult and Developmental Age, University of Messina, Via Consolare
Valeria 1, Messina, 98124, Italy.
| | - Davide Tinti
- Department of Pediatrics, University of
Turin, Torino, Italy
| | - Maria Francesca Messina
- Department of Human Pathology in Adult
and Developmental Age, University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult
and Developmental Age, University of Messina, Messina, Italy
| | - Ivana Rabbone
- Department of Pediatrics, University of
Turin, Torino, Italy
- Department of Science of Health, Hub
Regional Center of Pediatric Diabetology, University of Oriental Piemonte, Novara,
Italy
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Liu Y, Yu Q, Luo X, Yang L, Cui Y. Continuous monitoring of diabetes with an integrated microneedle biosensing device through 3D printing. MICROSYSTEMS & NANOENGINEERING 2021; 7:75. [PMID: 34631143 PMCID: PMC8481261 DOI: 10.1038/s41378-021-00302-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/14/2021] [Accepted: 08/10/2021] [Indexed: 05/14/2023]
Abstract
Diabetes is a prevalent chronic metabolic disease with multiple clinical manifestations and complications, and it is among the leading causes of death. Painless and continuous monitoring of interstitial glucose is highly desirable for diabetes management. Here we unprecedentedly show continuous monitoring of diabetes with an integrated microneedle biosensing device. The device was manufactured with a 3D printing process, a microfabrication process, an electroplating process, and an enzyme immobilization step. The device was inserted into the dermis layer of mouse skin and showed accurate sensing performance for monitoring subcutaneous glucose levels in normal or diabetic mice. The detection results were highly correlated with those obtained from a commercial blood glucose meter. We anticipate that the study could open exciting avenues for monitoring and managing diabetes, alongside fundamental studies of subcutaneous electronic devices.
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Affiliation(s)
- Yiqun Liu
- School of Materials Science and Engineering, Peking University, 100871 Beijing, P. R. China
| | - Qi Yu
- Renal Division, Peking University Institute of Nephrology, Peking University First Hospital, 100034 Beijing, P. R. China
| | - Xiaojin Luo
- School of Materials Science and Engineering, Peking University, 100871 Beijing, P. R. China
| | - Li Yang
- Renal Division, Peking University Institute of Nephrology, Peking University First Hospital, 100034 Beijing, P. R. China
| | - Yue Cui
- School of Materials Science and Engineering, Peking University, 100871 Beijing, P. R. China
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Teufel-Schäfer U, Huhn C, Müller S, Müller C, Grünert SC. Severe allergic contact dermatitis to two different continuous glucose monitoring devices in a patient with glycogen storage disease type 9b. Pediatr Dermatol 2021; 38:1302-1304. [PMID: 34418148 DOI: 10.1111/pde.14767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Continuous glucose monitoring (CGM) systems are of great value for patients with disorders of impaired glucose homeostasis, including glycogen storage diseases. We report on an 8-year-old girl with glycogen storage disease type 9b who developed severe allergic contact dermatitis to two different continuous glucose monitoring systems, FreeStyle® Libre and Dexcom® G6. Our case highlights the impact of sensitization for pediatric patients, the urgent need for open labeling of components by pharmaceutical and device manufacturers, and the need for avoidance of skin sensitizers in medical devices.
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Affiliation(s)
- Ulrike Teufel-Schäfer
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center- University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Christian Huhn
- Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Sabine Müller
- Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Christoph Müller
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center- University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Sarah Catharina Grünert
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center- University of Freiburg, Faculty of Medicine, Freiburg, Germany
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Kieu A, Govender RD, Östlundh L, King J. Benefits of the addition of continuous or flash glucose monitoring versus standard practice using self-monitored blood glucose and haemoglobin A1c in the primary care of diabetes mellitus: a systematic review protocol. BMJ Open 2021; 11:e050027. [PMID: 34446495 PMCID: PMC8395264 DOI: 10.1136/bmjopen-2021-050027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Studies demonstrate that optimal glycaemic control reduces morbidity from diabetes mellitus but remains elusive in a significant portion of patients. Although research shows that continuous glucose monitoring (CGM) and flash glucose monitoring (FGM) improves glycaemic control in selected subsets of patients with diabetes in specialty practices, we found no systematic reviews evaluating the use of CGM/FGM in primary care, where the majority of patients with diabetes are cared for.This systematic review aims to answer the questions: 'compared with usual care of self-monitoring blood glucose and haemoglobin A1c (HbA1c), does the addition of CGM/FGM use in the primary care of patients with diabetes improve glycaemic control, decrease rates of hypoglycaemia, and improve patient and physician satisfaction?' and if so, 'what subgroups of primary care patients with diabetes are most likely to benefit?'. METHODS AND ANALYSIS Aligning with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines, a search will be conducted in PubMed, EMBASE, Scopus, CINAHL, Cochrane Central Register of Controlled Trials and Web of Science. We will include studies investigating CGM/FGM use and reporting the primary outcome measure of HbA1c and secondary outcome measures of hypoglycaemia, time in range, time below range, time above range and patient/staff satisfaction. We will examine which patient populations appear to benefit from CGM/FGM. Three independent researchers will use the Covidence systematic review software for blinded screening and study selection. The National Heart, Lung, and Blood Institute quality assessment tool and Grading of Recommendations Assessment, Development and Evaluation will be used to assess the risk of bias and quality of evidence. ETHICS AND DISSEMINATION The systematic review methodology does not require ethics approval due to the nature of the study design. Study findings will be publicly available to a wide readership across disciplines and will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021229416.
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Affiliation(s)
- Alexander Kieu
- Department of Family Medicine, United Arab Emirates University, Al Ain, UAE
- Department of Family Medicine, Kanad Hospital, Al Ain, UAE
| | | | - Linda Östlundh
- National Medical Library, United Arab Emirates University, Al Ain, UAE
| | - Jeffrey King
- Department of Family Medicine, United Arab Emirates University, Al Ain, UAE
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Rigo RS, Levin LE, Belsito DV, Garzon MC, Gandica R, Williams KM. Cutaneous Reactions to Continuous Glucose Monitoring and Continuous Subcutaneous Insulin Infusion Devices in Type 1 Diabetes Mellitus. J Diabetes Sci Technol 2021; 15:786-791. [PMID: 32389062 PMCID: PMC8258506 DOI: 10.1177/1932296820918894] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) are the standard of care for type 1 diabetes in children. There is little reported on device-related skin complications and treatment options. This study documents cutaneous reactions to CGM and CSII devices in children and young adults with type 1 diabetes. METHODS One hundred and twenty-one subjects (3-25 years) with type 1 diabetes and CGM and/or CSII use were recruited over a three-month period from the Naomi Berrie Diabetes Center at Columbia University Irving Medical Center. A five-question survey was completed for each subject detailing demographic data, diabetes management, and device-related skin complications. RESULTS Sixty percent of subjects reported skin complications related to CGM and/or CSII use. Terms most frequently used to describe cutaneous reactions were "red," "itchy," "painful," and "rash." Subjects who used both CGM and CSII were more likely to report skin problems than those who used only CSII (odds ratio 2.9, [95% confidence interval: 1.2-6.7]; P = .015). There were no associations between skin complications and sex or race/ethnicity. Twenty-two percent of subjects with adverse skin event(s) discontinued use of a device due to their skin problem. Seven percent were evaluated by a dermatologist. Eighty-one percent used a range of products to treat their symptoms, with variable perceived clinical outcomes. CONCLUSIONS Skin complications related to CSII or CGM devices are commonly reported in pediatric patients with type 1 diabetes and may lead to interruption or discontinuation of device use. Future studies are needed to elucidate the causes of these reactions and determine the best methods for prevention.
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Affiliation(s)
- Rachel S. Rigo
- Columbia University Irving Medical Center, New York, NY, USA
| | - Laura E. Levin
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Donald V. Belsito
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Maria C. Garzon
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachelle Gandica
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Kristen M. Williams
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
- Kristen M. Williams, MD, Naomi Berrie Diabetes Center, Columbia University Irving Medical Center, 1150 Saint Nicholas Avenue, 2nd Floor, New York, NY 10032, USA.
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33
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Further Evidence of Allergic Contact Dermatitis Caused by 2,2'-Methylenebis(6-tert-Butyl-4-Methylphenol) Monoacrylate, a New Sensitizer in the Dexcom G6 Glucose Sensor. Dermatitis 2021; 33:287-292. [PMID: 34115662 DOI: 10.1097/der.0000000000000767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since the spring of 2020, we have seen several patients experiencing severe allergic contact dermatitis (ACD) from the Dexcom G6 glucose sensor after the composition of the sensor's adhesive patch had been changed. We have previously reported the finding of a new sensitizer, 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate, in the Dexcom G6 adhesive patch. Three patients with ACD from Dexcom G6 tested positive to this sensitizer. They were also allergic to isobornyl acrylate, a sensitizer present both in Dexcom G6 and in other medical devices previously used by these patients. OBJECTIVE The aim of the study was to report the first 4 cases sensitized to 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate without a simultaneous allergy to isobornyl acrylate. METHODS The cases were patch tested their own materials, a medical device series, and 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate in several concentrations. RESULTS All 4 cases tested positive to 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate at either 1.0% or 1.5% in petrolatum, whereas 20 controls tested negative to both concentrations. CONCLUSIONS The cases reported here provide further evidence of 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate as a relevant culprit sensitizer in patients with ACD from Dexcom G6. However, the initially used patch test concentration (0.3%) did not suffice to elicit positive reactions in these cases, which is why patch testing at 1.5% is recommended.
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Asarani NAM, Reynolds AN, Elbalshy M, Burnside M, de Bock M, Lewis DM, Wheeler BJ. Efficacy, safety, and user experience of DIY or open-source artificial pancreas systems: a systematic review. Acta Diabetol 2021; 58:539-547. [PMID: 33128136 DOI: 10.1007/s00592-020-01623-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023]
Abstract
The do-it-yourself artificial pancreas system (DIYAPS) is a patient-driven initiative with the potential to revolutionise diabetes management, automating insulin delivery with existing pumps and CGM combined with open-source algorithms. Given the considerable interest in this topic within the diabetes community, we have conducted a systematic review of DIYAPS efficacy, safety, and user experience. Following recognised procedures and reporting standards, we identified 10 eligible publications of 730 participants within the peer-reviewed literature. Overall, studies reported improvements in time in range, HbA1c (glycated haemoglobin), reduced hypoglycaemia, and improved quality of life with DIYAPS use. While results were positive, the identified studies were small, and the majority were observational and at high risk of bias. Further research including well-designed randomised trials comparing DIYAPS with appropriate comparators is recommended.
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Affiliation(s)
- N A M Asarani
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - A N Reynolds
- Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - M Elbalshy
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - M Burnside
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - M de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | | | - B J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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35
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Cowart K, Zgibor J. Flash Continuous Glucose Monitoring: A Practical Guide and Call to Action for Pharmacists. J Pharm Pract 2021; 35:638-646. [PMID: 33733910 DOI: 10.1177/08971900211000273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite advances in diabetes technology, the proportion of patients with type 2 diabetes achieving recommended glycemic goals remains suboptimal. There is a growing interest in flash continuous glucose monitoring (CGM) among patients, pharmacists and providers. Pharmacists are well positioned to collaborate with patients and providers in ambulatory care or community-based settings to allow a greater number of patients with diabetes to harness the benefits of flash CGM. The purpose of this narrative review is to provide pharmacists with a background on flash CGM technology, review the data supporting pharmacist-driven flash CGM services, and address common questions that arise in pharmacy practice surrounding flash CGM.
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Affiliation(s)
- Kevin Cowart
- Department of Pharmacotherapeutics & Clinical Research, Taneja College of Pharmacy, University of South Florida Tampa, FL, USA.,Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Janice Zgibor
- Department of Pharmacotherapeutics & Clinical Research, Taneja College of Pharmacy, University of South Florida Tampa, FL, USA.,College of Public Health, University of South Florida, Tampa, FL, USA
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36
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Heise HM, Delbeck S, Marbach R. Noninvasive Monitoring of Glucose Using Near-Infrared Reflection Spectroscopy of Skin-Constraints and Effective Novel Strategy in Multivariate Calibration. BIOSENSORS 2021; 11:bios11030064. [PMID: 33673679 PMCID: PMC7997402 DOI: 10.3390/bios11030064] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 05/10/2023]
Abstract
For many years, successful noninvasive blood glucose monitoring assays have been announced, among which near-infrared (NIR) spectroscopy of skin is a promising analytical method. Owing to the tiny absorption bands of the glucose buried among a dominating variable spectral background, multivariate calibration is required to achieve applicability for blood glucose self-monitoring. The most useful spectral range with important analyte fingerprint signatures is the NIR spectral interval containing combination and overtone vibration band regions. A strategy called science-based calibration (SBC) has been developed that relies on a priori information of the glucose signal ("response spectrum") and the spectral noise, i.e., estimates of the variance of a sample population with negligible glucose dynamics. For the SBC method using transcutaneous reflection skin spectra, the response spectrum requires scaling due to the wavelength-dependent photon penetration depth, as obtained by Monte Carlo simulations of photon migration based on estimates of optical tissue constants. Results for tissue glucose concentrations are presented using lip NIR-spectra of a type-1 diabetic subject recorded under modified oral glucose tolerance test (OGTT) conditions. The results from the SBC method are extremely promising, as statistical calibrations show limitations under the conditions of ill-posed equation systems as experienced for tissue measurements. The temporal profile differences between the glucose concentration in blood and skin tissue were discussed in detail but needed to be further evaluated.
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Affiliation(s)
- H. Michael Heise
- Interdisciplinary Center for Life Sciences, South-Westphalia University of Applied Sciences, Frauenstuhlweg 31, 58644 Iserlohn, Germany;
- Correspondence: ; Tel.: +49-2371-566412
| | - Sven Delbeck
- Interdisciplinary Center for Life Sciences, South-Westphalia University of Applied Sciences, Frauenstuhlweg 31, 58644 Iserlohn, Germany;
| | - Ralf Marbach
- CLAAS Selbstfahrende Erntemaschinen, Muehlenwinkel 1, 33428 Harsewinkel, Germany;
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Svedman C, Bruze M, Antelmi A, Hamnerius N, Hauksson I, Ulriksdotter J, Mowitz M. Continuous glucose monitoring systems give contact dermatitis in children and adults despite efforts of providing less ‘allergy‐ prone’ devices: investigation and advice hampered by insufficient material for optimized patch test investigations. J Eur Acad Dermatol Venereol 2021; 35:730-737. [DOI: 10.1111/jdv.16981] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Affiliation(s)
- C. Svedman
- Department of Occupational and Environmental Dermatology Lund UniversitySkåne University Hospital Malmö Sweden
| | - M. Bruze
- Department of Occupational and Environmental Dermatology Lund UniversitySkåne University Hospital Malmö Sweden
| | - A. Antelmi
- Department of Occupational and Environmental Dermatology Lund UniversitySkåne University Hospital Malmö Sweden
| | - N. Hamnerius
- Department of Occupational and Environmental Dermatology Lund UniversitySkåne University Hospital Malmö Sweden
| | - I. Hauksson
- Department of Occupational and Environmental Dermatology Lund UniversitySkåne University Hospital Malmö Sweden
| | - J. Ulriksdotter
- Department of Occupational and Environmental Dermatology Lund UniversitySkåne University Hospital Malmö Sweden
- Department of Dermatology Helsingborg Hospital Helsingborg Sweden
| | - M. Mowitz
- Department of Occupational and Environmental Dermatology Lund UniversitySkåne University Hospital Malmö Sweden
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38
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Scarlet Fever After Streptococcus pyogenes Skin Infection Associated With FreeStyle Libre Glucose Monitoring. Can J Diabetes 2021; 45:689-691. [PMID: 33582045 DOI: 10.1016/j.jcjd.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 11/08/2020] [Accepted: 11/22/2020] [Indexed: 11/20/2022]
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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40
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Zhou Y, Deng H, Liu H, Yang D, Xu W, Yao B, Yan J, Weng J. Effects of novel flash glucose monitoring system on glycaemic control in adult patients with type 1 diabetes mellitus: protocol of a multicentre randomised controlled trial. BMJ Open 2020; 10:e039400. [PMID: 33277281 PMCID: PMC7722373 DOI: 10.1136/bmjopen-2020-039400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Optimal glycaemic control is beneficial to prevent and delay microvascular complications in patients with type 1 diabetes mellitus (T1DM). The benefits of flash glucose monitoring (FGM) have been proved among well-controlled adults with T1DM, but evidence for FGM in adults with T1DM who have suboptimal glycaemic control is limited. This study aims to evaluate the effect of FGM in suboptimally controlled adult patients with T1DM . METHODS AND ANALYSIS This open-label, multicentre, randomised trial will be conducted at eight tertiary hospitals and recruit 104 adult participants (≥18 years old) with T1DM diagnosed for at least 1 year and with suboptimal glycaemic control (glycated haemoglobin (HbA1c) ranging from 7.0% to 10.0%). After a run-in period (baseline, 0-2 weeks), eligible participants will be randomised 1:1 to either use FGM or self-monitoring of blood glucose alone consequently for the next 24 weeks. At baseline, 12-14 weeks and 24-26 weeks, retrospective continuous glucose monitoring (CGM) systems will be used in both groups for device-related data collection. Biological metrics, including HbA1c, blood routine, lipid profiles, liver enzymes, questionnaires and adverse events, will be assessed at baseline, week 14 and week 26. All analyses will be conducted on the intent-to-treat population. Efficacy endpoint analyses will also be repeated on the per-protocol population. The primary outcome is the change of HbA1c from baseline to week 26. The secondary outcomes are the changes of CGM metrics, including time spent in range, time spent in target, time spent below range, time spent above range, SD, coefficient of variation, mean amplitude of glucose excursions, high or low blood glucose index, mean of daily differences, percentage of HbA1c in target (<7%), frequency of FGM use, total daily insulin dose and the scores of questionnaires including Diabetes Distress Scale, Hypoglycemia Fear Scale and European Quality of Life Scale. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University in January 2017. Ethical approval has been obtained at all centres. All participants will be provided with oral and written information about the trial. The study will be disseminated by peer-review publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03522870.
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Affiliation(s)
- Yongwen Zhou
- Department of Endocrinology, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China
- Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-sen University;Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, China
| | - Hongrong Deng
- Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-sen University;Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, China
| | - Hongxia Liu
- Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-sen University;Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, China
| | - Daizhi Yang
- Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-sen University;Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, China
| | - Wen Xu
- Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-sen University;Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, China
| | - Bin Yao
- Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-sen University;Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, China
| | - Jinhua Yan
- Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-sen University;Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, China
| | - Jianping Weng
- Department of Endocrinology, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China
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Marsters BL, Boucher SE, Galland BC, Wiltshire EJ, de Bock MI, Tomlinson PA, Rayns J, MacKenzie KE, Chan H, Wheeler BJ. Cutaneous adverse events in a randomized controlled trial of flash glucose monitoring among youth with type 1 diabetes mellitus. Pediatr Diabetes 2020; 21:1516-1524. [PMID: 32935921 DOI: 10.1111/pedi.13121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/13/2020] [Accepted: 08/28/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The literature regarding flash glucose monitoring (FGM)-associated cutaneous adverse events (AE) is limited. OBJECTIVES This study among youth participating in a 6 month randomized controlled trial aimed to compare cutaneous AE between FGM and self-monitored blood glucose (SMBG) use and evaluate premature FGM sensor loss. METHODS Patients aged 13 to 20 years with type 1 diabetes were randomized to intervention (FGM and usual care) or control (SMBG and usual care). Participants self-reported cutaneous AEs electronically every 14 days. Reports were analyzed to determine frequency, type, and severity of cutaneous AEs, and evaluate premature sensor loss. RESULTS Sixty-four participants were recruited; 33 randomized to FGM and 31 to control. In total, 80 cutaneous AEs were reported (40 in each group); however, the proportion of participants experiencing cutaneous AEs was greater in the FGM group compared to control (58% and 23% respectively, P = .004). FGM participants most frequently reported erythema (50% of AEs), while controls most commonly reported skin hardening (60% of AEs). For FGM users, 80.0% of cutaneous AEs were mild, 17.5% moderate, and 2.5% severe. Among controls, 82.5% of cutaneous AEs were mild and 17.5% moderate. One participant ceased using FGM due to recurring cutaneous AEs. Additionally, over 6 months, 82% of FGM participants experienced at least one premature sensor loss, largely unrelated to a cutaneous AE. CONCLUSIONS Cutaneous FGM-associated AEs are common, and mostly rated as mild. However, the majority of users continued FGM despite cutaneous AEs. Awareness of cutaneous complications and mitigation measures may reduce cutaneous AEs and improve the overall experience of FGM.
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Affiliation(s)
- Brooke L Marsters
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Sara E Boucher
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Barbara C Galland
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Esko J Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Martin I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand.,Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Paul A Tomlinson
- Paediatric Department, Southern District Health Board, Invercargill, New Zealand
| | - Jenny Rayns
- Endocrinology Department, Southern District Health Board, Dunedin, New Zealand
| | - Karen E MacKenzie
- Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Huan Chan
- Department of Endocrinology and General Medicine, Canterbury District Health Board, Christchurch, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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42
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Marsters BL, Boucher SE, Galland BC, de Lange M, Wiltshire EJ, de Bock MI, Elbalshy MM, Tomlinson PA, Rayns J, MacKenzie KE, Chan H, Wheeler BJ. The 'flash' adhesive study: a randomized crossover trial using an additional adhesive patch to prolong freestyle libre sensor life among youth with type 1 diabetes mellitus. Acta Diabetol 2020; 57:1307-1314. [PMID: 32519221 DOI: 10.1007/s00592-020-01556-y] [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] [Received: 03/31/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
AIMS Although strategies to prevent premature sensor loss for flash glucose monitoring (FGM) systems may have substantial benefit, limited data are available. This study among youth with high-risk type 1 diabetes evaluated whether an additional adhesive patch over FGM sensors would reduce premature sensor loss frequency and not cause additional cutaneous adverse events (AEs). METHODS This is a six-month, open-label, randomized crossover trial. Participants were recruited at completion of prior 'Managing Diabetes in a Flash' randomized controlled trial and allocated to three months of Freestyle Libre FGM sensors with either standard adhesive (control) or additional adhesive patches (RockaDex, New Zealand) (intervention), before crossing over to the opposite study arm. Participants self-reported patch use or non-use, premature sensor loss and cutaneous AEs fortnightly via an electronic questionnaire. RESULTS Thirty-four participants were enrolled: mean age (± SD) 17.0 (± 2.2) years; mean HbA1c (± SD) 89 (± 16) mmol/mol (10.3% ± 1.4%). The response rate of questionnaires was 77% (314/408). Premature sensor loss was reported in 18% (58/314) of questionnaires: 20% (32/162) from intervention and 17% (26/152) from control (p = 0.56). Thirty-eight percent (118/314) of questionnaires were non-compliant to protocol allocation. However, per-protocol analysis showed similar findings. No significant difference in AEs was reported between compliant adhesive patch use and non-use (6% [5/78] and 3% [3/118], respectively, p = 0.27). CONCLUSIONS The adhesive patch investigated in this study does not appear to prevent premature FGM sensor loss. However, the low risk of AEs and low cost of an adhesive patch suggest an individualized approach to their use may still be warranted. Further research is needed to explore alternative strategies to prevent sensor loss.
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Affiliation(s)
- Brooke L Marsters
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Sara E Boucher
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Barbara C Galland
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Michel de Lange
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Esko J Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Martin I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Mona M Elbalshy
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Paul A Tomlinson
- Paediatric Department, Southern District Health Board, Invercargill, New Zealand
| | - Jenny Rayns
- Endocrinology Department, Southern District Health Board, Dunedin, New Zealand
| | - Karen E MacKenzie
- Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Huan Chan
- Department of Endocrinology and General Medicine, Canterbury District Health Board, Christchurch, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.
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Ulriksdotter J, Svedman C, Bruze M, Glimsjö J, Källberg K, Sukakul T, Mowitz M. Contact dermatitis caused by glucose sensors-15 adult patients tested with a medical device patch test series. Contact Dermatitis 2020; 83:301-309. [PMID: 32608015 DOI: 10.1111/cod.13649] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several cases of allergic contact dermatitis (ACD) to the glucose sensor FreeStyle Libre have been reported. Isobornyl acrylate (IBOA) and N,N-dimethylacrylamide (DMAA) are known culprit allergens. OBJECTIVES To evaluate patients with suspected ACD to FreeStyle Libre in a standardized manner, present causative allergens, and assess patient-reported implications. METHODS A total of 15 patients with suspected ACD to FreeStyle Libre were patch tested with the Swedish baseline series and a new medical device series. IBOA and DMAA were tested at 0.1% and 0.3% in petrolatum (pet.). Readings were performed on day (D) 3 and D7. Background data, details on skin reactions, and associated implications were assessed using a questionnaire. RESULTS Thirteen patients were sensitized to IBOA and four to DMAA. Two positive reactions to IBOA and one to DMAA were seen only at 0.3% concentration on D7. Median duration of sensor use before dermatitis onset was 6 months. Half the number of the patients took precautions in everyday life due to sensor-related skin reactions. Six patients discontinued sensor usage. CONCLUSIONS Patients with suspected ACD to glucose sensors should be evaluated with a relevant patch test series containing IBOA and DMAA. Adding the 0.3% pet. concentration is recommended. The reading on D7 is necessary.
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Affiliation(s)
- Josefin Ulriksdotter
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Dermatology, Helsingborg Hospital, Helsingborg, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jenny Glimsjö
- Department of Medicine, Blekinge Hospital, Karlskrona, Sweden
| | - Kajsa Källberg
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Thanisorn Sukakul
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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44
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Herman A, Montjoye L, Baeck M. Adverse cutaneous reaction to diabetic glucose sensors and insulin pumps: Irritant contact dermatitis or allergic contact dermatitis? Contact Dermatitis 2020; 83:25-30. [DOI: 10.1111/cod.13529] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 01/18/2023]
Affiliation(s)
| | - Laurence Montjoye
- Department of DermatologyCliniques universitaires Saint‐Luc Brussels Belgium
| | - Marie Baeck
- Department of DermatologyCliniques universitaires Saint‐Luc Brussels Belgium
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45
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Boucher SE, Aum SH, Crocket HR, Wiltshire EJ, Tomlinson PA, de Bock MI, Wheeler BJ. Exploring parental perspectives after commencement of flash glucose monitoring for type 1 diabetes in adolescents and young adults not meeting glycaemic targets: a qualitative study. Diabet Med 2020; 37:657-664. [PMID: 31769551 DOI: 10.1111/dme.14188] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 12/11/2022]
Abstract
AIMS To explore parental perspectives after flash glucose monitoring commencement in adolescents and young adults with type 1 diabetes who were not meeting glycaemic targets. METHODS Twelve semi-structured interviews were conducted among parents of adolescents and young adults between the ages of 14 and 20 years (inclusive) with type 1 diabetes and not meeting glycaemic targets [HbA1c 81-130 mmol/mol (9.6-14.0%)] participating in a randomized controlled trial. Interviews were transcribed, then thematic analysis was performed to identify themes regarding parental experiences. RESULTS Four key themes were found: flash glucose monitoring improved parental emotional well-being; flash glucose monitoring reduced diabetes-specific conflict within families; flash glucose monitoring facilitated the parental role in diabetes management; and sensor-related challenges, particularly sensors falling off, interfered with using flash glucose monitoring for diabetes management. The cost of self-funded sensors was the only barrier to continuing flash glucose monitoring that parents reported. CONCLUSIONS This study provides new insights into the potential benefits and challenges of flash glucose monitoring use, drawn from the perspective of parents of adolescents and young adults not meeting glycaemic targets. As parents are often key partners in obtaining or purchasing this technology, these findings can be used to further inform parental expectations of this technology.
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Affiliation(s)
- S E Boucher
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - S Hye Aum
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - H R Crocket
- Faculty of Health, Sport and Human Performance, University of Waikato, Hamilton, New Zealand
| | - E J Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
- Capital and Coast District Health Board, Wellington, New Zealand
| | - P A Tomlinson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Southern District Health Board, Invercargill, New Zealand
| | - M I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Canterbury District Health Board, Christchurch, New Zealand
| | - B J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Southern District Health Board, Dunedin, New Zealand
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