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Boucsein A, Zhou Y, Michaels V, Haszard JJ, Jefferies C, Wiltshire E, Paul RG, Parry-Strong A, Pasha M, Petrovski G, de Bock MI, Wheeler BJ. Automated Insulin Delivery for Young People with Type 1 Diabetes and Elevated A1c. NEJM EVIDENCE 2024; 3:EVIDoa2400185. [PMID: 39315863 DOI: 10.1056/evidoa2400185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
BACKGROUND Automated insulin delivery is the treatment of choice in adults with type 1 diabetes. Data are needed on the efficacy and safety of automated insulin delivery for children and youth with diabetes and elevated glycated hemoglobin levels. METHODS In this multicenter, open-label randomized controlled trial, we assigned patients with type 1 diabetes in a 1:1 ratio either to use an automated insulin delivery system (MiniMed 780G) or to receive usual diabetes care of multiple daily injections or non--automated pump therapy (control). The patients were children and youth (defined as 7 to 25 years of age) with elevated glycemia (glycated hemoglobin ≥8.5% with no upper limit). The primary outcome was the baseline-adjusted between-group difference in glycated hemoglobin at 13 weeks. RESULTS A total of 80 patients underwent randomization (37 to automated insulin delivery and 43 to control) and all patients completed the trial. At 13 weeks, the mean (±SD) glycated hemoglobin decreased from 10.5±1.9% to 8.1±1.8% in the automated insulin delivery group but remained relatively consistent in the control group, changing from 10.4±1.6% to 10.6±1.8% (baseline-adjusted between-group difference, -2.5 percentage points; 95% confidence interval [CI], -3.1 to -1.8; P<0.001). Patients in the automated insulin delivery group spent on average 8.4 hours more in the target glucose range of 70 to 180 mg/dl than those in the control group. One severe hypoglycemia event and two diabetic ketoacidosis events occurred in the control group, with no such events in the automated insulin delivery group. CONCLUSIONS In this trial of 80 children and youth with elevated glycated hemoglobin, automated insulin delivery significantly reduced glycated hemoglobin compared with usual diabetes care, without resulting in severe hypoglycemia or diabetic ketoacidosis events. (Funded by Lions Clubs New Zealand District 202F and others; Australian New Zealand Clinical Trials Registry number, ACTRN12622001454763.).
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Affiliation(s)
- Alisa Boucsein
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Yongwen Zhou
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
- Department of Endocrinology, Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Clinical Research Hospital of Chinese Academy of Sciences (Hefei), University of Science and Technology of China (USTC), Hefei, Anhui, China
| | - Venus Michaels
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | | | - Craig Jefferies
- Starship Child Health, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
- Liggins Institute and Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Esko Wiltshire
- Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
- Te Whatu Ora Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Ryan G Paul
- Te Huatakia Waiora School of Health, University of Waikato, Hamilton, New Zealand
- Waikato Regional Diabetes Service, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Amber Parry-Strong
- Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
| | | | | | - Martin I de Bock
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
- Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
- Te Whatu Ora Southern, Dunedin, New Zealand
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2
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Boucsein A, Zhou Y, Haszard JJ, Jefferies CA, Wiltshire EJ, Styles SE, Crocket HR, Galland BC, Pasha M, Petrovski G, Paul RG, de Bock MI, Wheeler BJ. Protocol for a prospective, multicenter, parallel-group, open-label randomized controlled trial comparing standard care with Closed lOoP In chiLdren and yOuth with Type 1 diabetes and high-risk glycemic control: the CO-PILOT trial. J Diabetes Metab Disord 2024; 23:1397-1407. [PMID: 38932805 PMCID: PMC11196497 DOI: 10.1007/s40200-024-01397-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/04/2024] [Indexed: 06/28/2024]
Abstract
Purpose Advanced hybrid closed loop (AHCL) systems have the potential to improve glycemia and reduce burden for people with type 1 diabetes (T1D). Children and youth, who are at particular risk for out-of-target glycemia, may have the most to gain from AHCL. However, no randomized controlled trial (RCT) specifically targeting this age group with very high HbA1c has previously been attempted. Therefore, the CO-PILOT trial (Closed lOoP In chiLdren and yOuth with Type 1 diabetes and high-risk glycemic control) aims to evaluate the efficacy and safety of AHCL in this group. Methods A prospective, multicenter, parallel-group, open-label RCT, comparing MiniMed™ 780G AHCL to standard care (multiple daily injections or continuous subcutaneous insulin infusion). Eighty participants aged 7-25 years with T1D, a current HbA1c ≥ 8.5% (69 mmol/mol), and naïve to automated insulin delivery will be randomly allocated to AHCL or control (standard care) for 13 weeks. The primary outcome is change in HbA1c between baseline and 13 weeks. Secondary outcomes include standard continuous glucose monitor glycemic metrics, psychosocial factors, sleep, platform performance, safety, and user experience. This RCT will be followed by a continuation phase where the control arm crosses over to AHCL and all participants use AHCL for a further 39 weeks to assess longer term outcomes. Conclusion This study will evaluate the efficacy and safety of AHCL in this population and has the potential to demonstrate that AHCL is the gold standard for children and youth with T1D experiencing out-of-target glucose control and considerable diabetes burden. Trial registration This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry on 14 November 2022 (ACTRN12622001454763) and the World Health Organization International Clinical Trials Registry Platform (Universal Trial Number U1111-1284-8452). Supplementary Information The online version contains supplementary material available at 10.1007/s40200-024-01397-4.
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Affiliation(s)
- Alisa Boucsein
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Yongwen Zhou
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
- Department of Endocrinology, Institute of Endocrine and Metabolic Diseases, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, Clinical Research Hospital of Chinese Academy of Sciences (Hefei), University of Science and Technology of China (USTC), 230001 Hefei, Anhui China
| | | | - Craig A. Jefferies
- Starship Child Health, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
- Liggins Institute, Department of Paediatrics, The University of Auckland, Auckland, New Zealand
| | - Esko J. Wiltshire
- Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
- Te Whatu Ora Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Sara E. Styles
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Hamish R. Crocket
- Te Huatakia Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | - Barbara C. Galland
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | | | | | - Ryan G. Paul
- Te Huatakia Waiora School of Health, University of Waikato, Hamilton, New Zealand
- Waikato Regional Diabetes Service, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Martin I. de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| | - Benjamin J. Wheeler
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
- Te Whatu Ora Southern, Dunedin, New Zealand
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3
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Rose S, Styles SE, Wiltshire EJ, Stanley J, Galland BC, de Bock MI, Tomlinson PA, Rayns JA, MacKenzie KE, Wheeler BJ. Use of intermittently scanned continuous glucose monitoring in young people with high-risk type 1 diabetes-Extension phase outcomes following a 6-month randomized control trial. Diabet Med 2022; 39:e14756. [PMID: 34862661 DOI: 10.1111/dme.14756] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
Abstract
AIMS To describe the impact of a 12-month intervention using intermittently scanned continuous glucose monitoring (isCGM) on glycaemic control and glucose test frequency in adolescents and young adults with type 1 diabetes (T1D) and high-risk glycaemic control (HbA1c ≥75 mmol/mol [≥9.0%]). METHODS In total, 64 young people (aged 13-20 years, 16.6 ± 2.1 years; 48% female; 41% Māori or Pacific ethnicity; mean diabetes duration 7.5 ± 3.8 years) with T1D were enrolled in a 6-month, randomized, parallel-group study comparing glycaemic outcomes from the isCGM intervention (n = 33) to self monitoring blood glucose (SMBG) controls (n = 31). In this 6-month extension phase, both groups received isCGM; HbA1c , glucose time-in-range (TIR), and combined glucose test frequency were assessed at 9 and 12 months. RESULTS At 12 months, the mean difference in HbA1c from baseline was -4 mmol/mol [-0.4%] (95% confidence interval, CI: -8, 1 mmol/mol [-0.8, 0.1%]; p = 0.14) in the isCGM intervention group, and -7 mmol/mol [-0.7%] (95% CI: -16, 1 mmol/mol [-1.5, 0.1%]; p = 0.08) in the SMBG control group. No participants achieved ≥70% glucose TIR (3.9-10.0 mmol/L). The isCGM intervention group mean rate of daily glucose testing was highest at 9 months, 2.4 times baseline rates (p < 0.001), then returned to baseline by 12 months (incidence rate ratio = 1.4; 95% CI: 0.9, 2.1; p = 0.091). CONCLUSIONS The use of isCGM in young people with high-risk T1D resulted in transient improvements in HbA1c and glucose monitoring over a 9-month time frame; however, benefits were not sustained to 12 months.
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Affiliation(s)
- Shelley Rose
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
| | - Sara E Styles
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Esko J Wiltshire
- Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
- Paediatric Department, Capital and Coast District Health Board, Wellington, New Zealand
| | - James Stanley
- Biostatistical Group, Dean's Department, University of Otago Wellington, Wellington, New Zealand
| | - Barbara C Galland
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, 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 A Rayns
- Endocrinology Department, Southern District Health Board, Dunedin, New Zealand
| | - Karen E MacKenzie
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Paediatric Department, 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
- Paediatric Department, Southern District Health Board, Dunedin, New Zealand
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Styles S, Wheeler B, Boucsein A, Crocket H, de Lange M, Signal D, Wiltshire E, Cunningham V, Lala A, Cutfield W, de Bock M, Serlachius A, Jefferies C. A comparison of FreeStyle Libre 2 to self-monitoring of blood glucose in children with type 1 diabetes and sub-optimal glycaemic control: a 12-week randomised controlled trial protocol. J Diabetes Metab Disord 2021; 20:2093-2101. [PMID: 34900845 PMCID: PMC8630241 DOI: 10.1007/s40200-021-00907-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
Abstract
Purpose Frequent glucose monitoring is necessary for optimal glycaemic control. Second-generation intermittently scanned glucose monitoring (isCGM) systems inform users of out-of-target glucose levels and may reduce monitoring burden. We aim to compare FreeStyle Libre 2 (Abbott Diabetes Care, Witney, U.K.) to self-monitoring of blood glucose in children with type 1 diabetes and sub-optimal glycaemic control. Methods This open-label randomised controlled trial will enrol 100 children (4–13 years inclusive, diagnosis of type 1 diabetes ≥ 6 months, HbA1c 58–110 mmol/mol [7.5–12.2%]), from 5 New Zealand diabetes centres. Following 2 weeks of blinded sensor wear, children will be randomised 1:1 to control or intervention arms. The intervention (duration 12 weeks) includes second-generation isCGM (FreeStyle Libre 2) and education on using interstitial glucose data to manage diabetes. The control group will continue self-monitoring blood glucose. The primary outcome is the difference in glycaemic control (measured as HbA1c) between groups at 12 weeks. Pre-specified secondary outcomes include change in glucose monitoring frequency, glycaemic control metrics and psychosocial outcomes at 12 weeks as well as isCGM acceptability. Discussion This research will investigate the effectiveness of the second-generation isCGM to promote recommended glycaemic control. The results of this trial may have important implications for including this new technology in the management of children with type 1 diabetes. Trial registration This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry on 19 February 2020 (ACTRN12620000190909p) and the World Health Organization International Clinical Trials Registry Platform (Universal Trial Number U1111-1237-0090).
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Affiliation(s)
- Sara Styles
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Ben Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,Paediatrics, Southern District Health Board, Dunedin, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Alisa Boucsein
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Hamish Crocket
- Health, Sport and Human Performance, School of Health, University of Waikato, Hamilton, New Zealand
| | - Michel de Lange
- Centre for Biostatistics, Te Pokapū Tatauranga Koiora, Division of Health Sciences, Dunedin, New Zealand
| | - Dana Signal
- Paediatric Diabetes and Endocrinology, Starship Children's Health, Auckland, New Zealand.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Esko Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, Wellington, New Zealand.,Capital & Coast District Health Board, Wellington, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | | | - Anita Lala
- Paediatrics, Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Wayne Cutfield
- Paediatric Diabetes and Endocrinology, Starship Children's Health, Auckland, New Zealand.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Anna Serlachius
- Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Craig Jefferies
- Paediatric Diabetes and Endocrinology, Starship Children's Health, Auckland, New Zealand.,Liggins Institute, The University of Auckland, Auckland, New Zealand
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5
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Sehgal S, De Bock M, Williman J, Taylor B, Elbalshy M, Galland B, Hall R, Paul R, Boucsein A, Jones S, Frewen C, Wheeler BJ. Study protocol: Safety and efficacy of smart watch integrated do-it-yourself continuous glucose monitoring in adults with Type 1 diabetes, a randomised controlled trial. J Diabetes Metab Disord 2021; 20:2103-2113. [PMID: 34900846 PMCID: PMC8630291 DOI: 10.1007/s40200-021-00923-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/16/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Type 1 diabetes (T1D) management requires regular monitoring of glucose levels and judicious therapeutic administration of insulin to prevent both microvascular and macrovascular complications. Few people with diabetes are able to sustain the self-monitored blood glucose measurements needed for optimal care, and those that do, typically experience significant diabetes-related distress. Both intermittently scanned continuous glucose monitoring (isCGM) and continuous glucose monitoring (CGM) offer alternatives to reduce the overall burden, but both still have limitations. Given the expense of CGM, smart watch integrated do-it-yourself (DIY)-CGM has been developed as an alternative to commercial isCGM and CGM technologies. This study has been designed to evaluate the clinical efficacy of smart watch integrated DIY-CGM compared with isCGM in adults with T1D. METHODS This multicentre, randomised, crossover study will be conducted in New Zealand and aims to recruit 60 adults with established T1D who currently use isCGM. DIY-CGM will be compared to usual care with isCGM. Participants will be randomised to either arm of the study for 8 weeks followed by a 4-week washout period before crossing over to the other study arm for a further 8 weeks. The primary endpoint is glucose time in range (TIR) defined as percentage of time interstitial glucose is spent between 3.9 to 10 mmol/L for the entire intervention period. Secondary endpoints include diabetes-related quality of life, distress, and sleep quality in participants and their partners. DISCUSSION The results of this study will provide clinical trial data regarding smart watch integrated DIY-CGM versus isCGM for improving glycaemic control in adults with T1D, and also report a variety of key secondary outcomes, including changes in subjective outcome measures for both people with diabetes and their partners. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12621000648820,31 May 2021); World Health Organisation International Clinical Trial Registry Platform (U1111-1262-2784, 3rd December 2020).
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Affiliation(s)
- Shekhar Sehgal
- Department of Women’s and Children’s Health, Dunedin School of Medicine, Otago Medical School, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Martin De Bock
- Department of Paediatrics, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140 New Zealand
| | - Jonathan Williman
- Department of Paediatrics, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140 New Zealand
| | - Barry Taylor
- Department of Women’s and Children’s Health, Dunedin School of Medicine, Otago Medical School, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Mona Elbalshy
- Department of Women’s and Children’s Health, Dunedin School of Medicine, Otago Medical School, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Barbara Galland
- Department of Women’s and Children’s Health, Dunedin School of Medicine, Otago Medical School, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Rosemary Hall
- Department of Endocrinology and Diabetes, Capital and Coast District Health Board, Wellington, New Zealand
| | - Ryan Paul
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Alisa Boucsein
- Department of Women’s and Children’s Health, Dunedin School of Medicine, Otago Medical School, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Shirley Jones
- Department of Women’s and Children’s Health, Dunedin School of Medicine, Otago Medical School, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Carla Frewen
- Department of Women’s and Children’s Health, Dunedin School of Medicine, Otago Medical School, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Benjamin J. Wheeler
- Department of Women’s and Children’s Health, Dunedin School of Medicine, Otago Medical School, University of Otago, PO Box 56, Dunedin, New Zealand
- Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand
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6
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Rose S, Boucher SE, Galland BC, Wiltshire EJ, Stanley J, Smith C, de Bock MI, Rayns JA, MacKenzie KE, Wheeler BJ. Impact of high-risk glycemic control on habitual sleep patterns and sleep quality among youth (13-20 years) with type 1 diabetes mellitus compared to controls without diabetes. Pediatr Diabetes 2021; 22:823-831. [PMID: 33880853 DOI: 10.1111/pedi.13215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/28/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In type 1 diabetes mellitus (T1D), glycemic control and sleep have a bidirectional relationship, with unhealthy glycemic control impacting sleep, and inadequate sleep impacting diabetes management. Youth are at risk for poor quality sleep; however, little is known about sleep among youth with high-risk glycemic control. OBJECTIVE To assess differences in habitual sleep timing, duration, and quality among youth with T1D and controls. SUBJECTS Two-hundred-thirty youth (13-20 years): 64 with T1D (mean age 16.6 ± 2.1 years, 48% female, diabetes duration 7.5 ± 3.8 years, HbA1c 96 ± 18.0 mmol/mol [10.9 ± 1.7%]), and 166 controls (mean age 15.3 ± 1.5, 58% female). METHODS Comparison of data from two concurrent studies (from the same community) using subjective and objective methods to assess sleep in youth: Pittsburgh Sleep Quality Index evaluating sleep timing and quality; 7-day actigraphy measuring habitual sleep patterns. Regression analyses were used to compare groups. RESULTS When adjusted for various confounding factors, youth with T1D reported later bedtimes (+36 min; p < 0.05) and shorter sleep duration (-53 min; p < 0.05) than controls, and were more likely to rate subjective sleep duration (OR 3.57; 95% CI 1.41-9.01), efficiency (OR 4.03; 95% CI 1.43-11.40), and quality (OR 2.59; 95% CI 1.16-5.76) as "poor" (p < 0.05). However, objectively measured sleep patterns were similar between the two groups. CONCLUSIONS Youth with high-risk T1D experience sleep difficulties, with later bedtimes contributing to sleep deficit. Despite a lack of objective differences, they perceive their sleep quality to be worse than peers without diabetes.
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Affiliation(s)
- Shelley Rose
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Department of Pediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
| | - Sara E Boucher
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Barbara C Galland
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Esko J Wiltshire
- Department of Pediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand.,Pediatric Department, Capital and Coast District Health Board, Wellington, New Zealand
| | - James Stanley
- Biostatistical Group, Dean's Department, University of Otago Wellington, Wellington, New Zealand
| | - Claire Smith
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Martin I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand.,Pediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Jenny A Rayns
- Endocrinology Department, Southern District Health Board, Dunedin, New Zealand
| | - Karen E MacKenzie
- Department of Paediatrics, University of Otago, Christchurch, New Zealand.,Pediatric Department, 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.,Pediatric Department, Southern District Health Board, Dunedin, New Zealand
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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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8
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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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9
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Boucher SE, Gray AR, Wiltshire EJ, de Bock MI, Galland BC, Tomlinson PA, Rayns JA, MacKenzie KE, Chan H, Rose S, Wheeler BJ. Effect of 6 Months of Flash Glucose Monitoring in Youth With Type 1 Diabetes and High-Risk Glycemic Control: A Randomized Controlled Trial. Diabetes Care 2020; 43:2388-2395. [PMID: 32788281 DOI: 10.2337/dc20-0613] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/15/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether intermittently scanned continuous glucose monitoring (isCGM) significantly improves glycemic control compared with capillary self-monitored blood glucose (SMBG) in youth with type 1 diabetes and high-risk glycemic control. RESEARCH DESIGN AND METHODS This multicenter 6-month randomized, controlled, parallel-arm trial included 64 participants aged 13-20 years with established type 1 diabetes and glycated hemoglobin (HbA1c) ≥9% (≥75 mmol/mol). Participants were allocated to 6-month intervention (isCGM; FreeStyle Libre; Abbott Diabetes Care, Witney, U.K.) (n = 33) or control (SMBG; n = 31) using minimization. The primary outcome was the difference in change in HbA1c from baseline to 6 months. RESULTS There was no evidence of a difference between groups for changes in HbA1c at 6 months (adjusted mean 0.2% greater improvement for isCGM [95% CI -0.9 to 0.5] [-2.1 mmol/mol (95% CI -9.6 to 5.4)]; P = 0.576). However, glucose-monitoring frequency was 2.83 (95% CI 1.72-4.65; P < 0.001) times higher in the isCGM group compared with that in the SMBG group at 6 months. The change in the Diabetes Treatment Satisfaction Questionnaire mean item score also favored isCGM at 6 months (P = 0.048), with no significant differences between groups for fear of hypoglycemia and quality of life (both general and diabetes specific) (all P > 0.1). CONCLUSIONS For youth with high-risk glycemic control, isCGM led to improvements in glucose testing frequency and diabetes treatment satisfaction. However, these did not translate to greater improvement in glycemic control over usual care with SMBG at 6 months.
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Affiliation(s)
- Sara E Boucher
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew R Gray
- 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, Wellington, New Zealand.,Capital & Coast District Health Board, Wellington, New Zealand
| | - Martin I de Bock
- Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Barbara C Galland
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Paul A Tomlinson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jenny A 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
| | - Shelley Rose
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand .,Paediatric Department, Southern District Health Board, Dunedin, New Zealand
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10
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Al Hayek AA, Al Dawish MA. Assessing Diabetes Distress and Sleep Quality in Young Adults with Type 1 Diabetes Using FreeStyle Libre: A Prospective Cohort Study. Diabetes Ther 2020; 11:1551-1562. [PMID: 32495021 PMCID: PMC7324459 DOI: 10.1007/s13300-020-00849-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The burden of diabetes, its potential complications, and related self-care activities can induce negative psychosocial effects in patients with type 1 diabetes mellitus (T1DM). This prospective cohort study investigated the psychosocial benefits associated with 3 months of FreeStyle Libre (FSL) flash glucose monitoring use in young adults with T1DM in Saudi Arabia. METHODS Patients completed the Diabetes Distress Scale (DDS) and the Pittsburgh Sleep Quality Index (PSQI) questionnaires at baseline and 3 months. HbA1c, number of confirmed hypoglycemia episodes per month, and frequency of blood glucose testing were also collected at baseline and 3 months. RESULTS Of 95 patients analyzed, significant reductions were observed in mean DDS (3.8 vs. 2.5; p < 0.001) and PSQI (8.7 vs. 3.9; p < 0.001) scores from baseline to 3 months. Furthermore, HbA1c and confirmed hypoglycemia episodes per month also decreased from baseline to 3 months (HbA1c 8.3 vs. 7.7% [67 vs. 61 mmol/mol], p < 0.001; hypoglycemia episodes 3.0 vs. 2.3, p < 0.001). In contrast, mean frequency of blood glucose testing per day increased from baseline to 3 months (2.5 vs. 5.2; p < 0.001). CONCLUSION These data demonstrate improvements in diabetes distress and sleep quality as well as glycemic outcomes following 3 months' FSL use in young adults with T1DM.
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Affiliation(s)
- Ayman A Al Hayek
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Mohamed A Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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11
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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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12
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Maahs DM, Shalitin S. Diabetes Technology and Therapy in the Pediatric Age Group. Diabetes Technol Ther 2020; 22:S89-S108. [PMID: 32069148 DOI: 10.1089/dia.2020.2507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- David M Maahs
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
- Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA
| | - Shlomit Shalitin
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Initial experiences of adolescents and young adults with type 1 diabetes and high-risk glycemic control after starting flash glucose monitoring - a qualitative study. J Diabetes Metab Disord 2019; 19:37-46. [PMID: 32550154 DOI: 10.1007/s40200-019-00472-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/20/2019] [Indexed: 12/18/2022]
Abstract
Purpose This study explored early experiences with a flash glucose monitoring system among adolescents and young adults with type 1 diabetes and high-risk glycemic control. Methods Adolescents and young adults with high-risk glycemic control (HbA1c ≥ 75 mmol/mol (9.0%) in the previous 6 months) who had recently commenced on flash glucose monitoring as part of a trial took part in a semi-structured interview exploring their experiences with the technology. All interviews were recorded, transcribed and analyzed using an inductive approach. Results Fifteen interviews were conducted. Overall, participants enjoyed flash glucose monitoring and planned to continue using their system. Key findings included flash glucose monitoring reduced diabetes management burden and increased glucose monitoring. Other impacts of flash glucose monitoring use included perceived improved mood and energy, increased capacity for physical activity and less parental conflict. While participants reported healthier glycemic control, participants' mean interstitial glucose level remained above the target range of 3.9-10.0 mmol/L (70-180 mg/dL) over the first month of flash glucose monitoring. Common challenges included premature sensor loss and decreased scanning over the first month of use. Conclusions Flash glucose monitoring may be an acceptable self-management tool to increase monitoring frequency in adolescents and young adults with type 1 diabetes and high-risk glycemic control, with the potential to improve long-term glycemic control. Initial support efforts should focus on practical strategies to prolong sensor wear and motivate frequent scanning as well as education on interpreting glucose data and making informed treatment decisions to maximize the benefits of this technology.
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