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Miyazaki B, Zeier T, Barber ROLB, Espinoza JC, Chao LCC. Expansion of Medicaid Coverage of Continuous Glucose Monitor Reduces Health Disparity in Children and Young Adults With Type 1 Diabetes. J Diabetes Sci Technol 2024:19322968241287217. [PMID: 39397768 DOI: 10.1177/19322968241287217] [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: 10/15/2024]
Abstract
BACKGROUND Continuous glucose monitor (CGM) usage improves glycemia in people with type 1 diabetes (PWD) and is accepted as the standard of care. The CGM utilization is lower in patients with public insurance and minorized ethnicities. In 2022, California Medicaid reduced its barriers to obtaining CGM coverage for PWD. It is unknown whether this policy change is sufficient to increase CGM usage. We hypothesize that the change in Medicaid coverage improved CGM uptake in children and young adults with T1D. METHODS Data were extracted from electronic medical record of a large urban children's hospital in 2021 and 2022. The CGM usage was determined based on clinician documentation or the presence of CGM downloads. Kruskal-Wallis tests, Wald tests, and χ2 tests were used to test hypothesis (P < .05). Mixed effects logistical regression analyses were performed. RESULTS We included 878 and 892 PWD (age ≤ 21 years) in 2021 and 2022, respectively. In 2022, Medicaid insured 59.3% of patients. Between 2021 and 2022, CGM usage did not change for privately insured patients (84%) but increased from 41% to 58% for patients receiving Medicaid. In our mixed effects logistic regression model, CGM usage was higher in 2022 and in English speakers. Public insurance, black race, and patients' age were negatively associated with CGM usage. CONCLUSION Our results suggest that Medicaid expansion of CGM coverage increases its utilization for pediatric PWD but did not eliminate the disparity. Future studies are needed to identify barriers that preclude equity in technology uptake.
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Affiliation(s)
- Brian Miyazaki
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Troy Zeier
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Juan Carlos Espinoza
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Lily Chih-Chen Chao
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Lippi G, Pighi L, Mattiuzzi C. Update on Patient Self-Testing with Portable and Wearable Devices: Advantages and Limitations. Diagnostics (Basel) 2024; 14:2037. [PMID: 39335715 PMCID: PMC11431615 DOI: 10.3390/diagnostics14182037] [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: 08/29/2024] [Revised: 09/11/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024] Open
Abstract
Laboratory medicine has undergone a deep and multifaceted revolution in the course of human history, in both organizational and technical terms. Over the past century, there has been a growing recognition of the need to centralize numerous diagnostic activities, often similar or identical but located in different clinical departments, into a common environment (i.e., the medical laboratory service), followed by a progressive centralization of tests from smaller laboratories into larger diagnostic facilities. Nevertheless, the numerous technological advances that emerged at the beginning of the new millennium have helped to create a new testing culture characterized by a countervailing trend of decentralization of some tests closer to patients and caregivers. The forces that have driven this (centripetal) counter-revolution essentially include a few key concepts, namely "home testing", "portable or even wearable devices" and "remote patient monitoring". By their very nature, laboratory medical services and remote patient testing/monitoring are not contradictory, but may well coexist, with the choice of one or the other depending on the demographic and clinical characteristics of the patient, the type of analytical procedure and the logistics and local organization of the care system. Therefore, this article aims to provide a general overview of patient self-testing, with a particular focus on portable and wearable (including implantable) devices.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, P.le Ludovico Scuro 10, 37134 Verona, Italy;
| | - Laura Pighi
- Section of Clinical Biochemistry, University of Verona, P.le Ludovico Scuro 10, 37134 Verona, Italy;
| | - Camilla Mattiuzzi
- Medical Direction, Rovereto Hospital, Privincial Trust for Social and Sanitary Services, Corso Verona, 4, 38068 Rovereto, Italy;
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3
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Gómez-Peralta F, Pinés-Corrales PJ, Santos E, Cuesta M, González-Albarrán O, Azriel S. Diabetes Management Based on the Phenotype and Stage of the Disease: An Expert Proposal from the AGORA Diabetes Collaborative Group. J Clin Med 2024; 13:4839. [PMID: 39200982 PMCID: PMC11355114 DOI: 10.3390/jcm13164839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 09/02/2024] Open
Abstract
Diabetes is a complex and rapidly growing disease with heterogeneous clinical presentations. Recent advances in molecular and genetic technologies have led to the identification of various subtypes of diabetes. These advancements offer the potential for a more precise, individualized approach to treatment, known as precision medicine. Recognizing high-risk phenotypes and intervening early and intensively is crucial. A staging system for type 1 diabetes has been proposed and accepted globally. In this article, we will explore the different methods for categorizing and classifying type 2 diabetes (T2D) based on clinical characteristics, progression patterns, risk of complications, and the use of molecular techniques for patient grouping. We, as a team of experts, will also present an easy-to-follow treatment plan and guidance for non-specialists, particularly primary care physicians, that integrates the classification and staging of diabetes. This will help ensure that the most suitable therapy is applied to the different types of T2D at each stage of the disease's progression.
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Affiliation(s)
| | - Pedro J. Pinés-Corrales
- Endocrinology and Nutrition Service, Complejo Hospitalario Universitario de Albacete, 02008 Albacete, Spain;
| | - Estefanía Santos
- Endocrinology and Nutrition Service, Complejo Hospitalario de Burgos, 09006 Burgos, Spain;
| | - Martín Cuesta
- Endocrinology and Nutrition Service, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | | | - Sharona Azriel
- Endocrinology and Nutrition Service, Hospital Universitario Infanta Sofía, 28702 San Sebastián De Los Reyes, Spain;
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4
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Olinger AL, Sachdeva S, Manzardo AM, Cain SE. Managing Type 1 Diabetes in an Inpatient Child Psychiatric Care Setting. Diabetes Spectr 2024; 37:234-240. [PMID: 39157783 PMCID: PMC11327167 DOI: 10.2337/dsi24-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Individuals with diabetes are at increased risk for psychological, behavioral, and social problems. Comorbid mental illness and diabetes present a unique set of challenges for people with diabetes and their health care providers, particularly in an inpatient setting. Psychiatric symptoms before admission may affect type 1 diabetes management, and mental status and behavior can affect individuals' ability to cooperate with treatment while they are inpatients. This article describes a clinical protocol to manage type 1 diabetes and maximize patient safety in an acute inpatient child psychiatric unit.
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Affiliation(s)
- Amanda L. Olinger
- Departments of Psychiatry & Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Shilpa Sachdeva
- Departments of Psychiatry & Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Ann M. Manzardo
- Departments of Psychiatry & Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Sharon E. Cain
- Departments of Psychiatry & Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, KS
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5
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Williamson RJ, Powell R, Shepherd AK. Improving Diabetic Care Through Education and Innovation. J Dr Nurs Pract 2024; 17:86-99. [PMID: 39103191 DOI: 10.1891/jdnp-2023-0060] [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] [Indexed: 08/07/2024]
Abstract
Background: Despite the innovative advancements in diabetes care, providers may not recognize patients with type 2 diabetes mellitus (T2DM) who qualify for a continuous glucose monitoring (CGM) device or the benefits of a telemedicine program for improving self-management behaviors. Objective: This quality improvement (QI) project aimed to determine if an advanced practice registered nurse (APRN)-led telemedicine program using CGM could improve glycemic control and self-management in patients with insulin-dependent T2DM. Methods: A 6-week telemedicine program was developed and implemented using the CGM's time-in-range to deliver patient-specific education. Clinical metrics were collected at each visit. All patients completed a pre- and postintervention Diabetes Self-Management Questionnaire-Revised (DSMQ-R) survey. Results: A repeated measures analysis of variance revealed that the telemedicine program had a statistically significant impact on time-in-range outcomes, F(2, 14) = 18.203, p < .001. Paired-samples t tests indicate that APRN-led education improved body mass index, t(8) = 4.232, p = .002; decreased systolic blood pressure, t(8) = 2.90, p = .010, and diastolic blood pressure, t(8) = 3.21, p = .007; and increased self-management skills as evidenced by DSMQ-R, t(8) = -5.498, p < .001. Conclusions: This QI project highlights multiple interventions for improving diabetes management in a primary care facility. Implications for Nursing: An APRN-led telemedicine program integrating CGM time-in-range data can improve glycemic control and self-management skills in patients with T2DM who administer insulin.
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Affiliation(s)
- Riki J Williamson
- Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA
| | - Renea Powell
- Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA
| | - Andrea K Shepherd
- Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA
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6
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Preechasuk L, Avari P, Oliver N, Reddy M. Switching from Intermittently Scanned Continuous Glucose Monitoring to Real-Time Continuous Glucose Monitoring with a Predictive Urgent Low Soon Alert Reduces Exposure to Hypoglycemia. Diabetes Technol Ther 2024; 26:498-502. [PMID: 38315504 DOI: 10.1089/dia.2023.0434] [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: 02/07/2024]
Abstract
Differences in the effectiveness of real-time continuous glucose monitoring (rtCGM) and intermittently scanned continuous glucose monitoring (isCGM) in type 1 diabetes (T1D) are reported. The impact on percent time in range of switching from an isCGM with glucose threshold-based optional alerts only (FreeStyle Libre 2 [FSL2]) to an rtCGM (Dexcom G7) with an urgent low soon predictive alert was assessed, alongside other secondary outcomes including hemoglobin A1c (HbA1c) and other continuous glucose monitoring metrics. Adults with T1D using FSL2 were switched to Dexcom G7 for 12 weeks. HbA1c and continuous glucose data during FSL2 and Dexcom G7 use were compared. Data from 29 participants (aged 44.8 ± 16.5 years, 12 male and 17 female) were analyzed. After switching to rtCGM, participants spent less time in hypoglycemia below 3.9 mmol/L (70 mg/dL) (3.0% [1.0%, 5.0%] vs. 2.0% [1.0%, 3.0%], P = 0.006) and had higher percentage achievement of time below 3.9 mmol/L (70 mg/dL) of <4% (55.2% vs. 82.8%, P = 0.005). Coefficient of variation was lower (39.3 ± 6.6% vs. 37.2 ± 5.6%, P = 0.008). In conclusion, adults with T1D who switched from isCGM to rtCGM may benefit from reduced exposure to hypoglycemia and glycemic variability.
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Affiliation(s)
- Lukana Preechasuk
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Siriraj Diabetes Center of Excellence, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Parizad Avari
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Monika Reddy
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
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7
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Manov A, Haddadin R, Chauhan S, Benge E. Retrospective, Longitudinal, One-Group Study on the Implementation of Continuous Glucose Monitoring To Improve Quality of Care for Patients With Type I or II Diabetes Mellitus in an Internal Medicine Residency Continuity Community Clinic. Cureus 2024; 16:e64594. [PMID: 39149659 PMCID: PMC11325259 DOI: 10.7759/cureus.64594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 08/17/2024] Open
Abstract
In this three-year retrospective study, data from 51 patients with type 1 or type 2 diabetes mellitus (DM), receiving a minimum of 3-4 insulin injections per day and self-monitoring their blood glucose (SMBG) four times a day, were derived from our internal medicine residency primary care clinic. The patients were equipped with a continuous glucose monitoring (CGM) device that shared 24-hour glucose data with the clinic. They were assigned to members of our CGM team, which included internal medicine or transitional year medical residents who functioned under the supervision of a board-certified endocrinologist. The residents, in consultation with our endocrinologist, assessed the patients' glucose management data and adjusted their treatment regimens biweekly by calling the patients, and monthly by seeing the patients in the clinic. Significant results from the study include a reduction in HbA1c from 9.9% to 7.6%, an average blood glucose decrement from 242 mg/dL to 169 mg/dL, a reduction in the incidence of mild hypoglycemia from below 70 mg/dL to 54 mg/dL, from 4.68% to 0.76% per day, and a more pronounced hypoglycemia with glucose less than 54 mg/dL from 3.1% per day to 0.2% per day. We observed a significant increase in the time in the range of the blood glucose from 33% to 67% per day. Furthermore, 9.5% of the patients in this study eventually discontinued their daily insulin injections and continued treatment with oral diabetic medications with or without the use of injectable GLP-1 receptors once a week. Our study affirms that CGM devices significantly improve glycemic control compared to SMBG, supporting its efficacy in optimizing glycemic control in real-world clinical practice. The results imply that this can be accomplished in internal medicine residency clinics and not exclusively in specialized endocrine clinics. As far as we know, this is the first study of its kind in a residency clinic in the USA. This study confirms the benefits of widening the application of CGM in DM, along with the challenges that must be overcome to realize the evidence-based benefits of this technology. CGM needs to become a part of routine monitoring for type 1 and type 2 DM.
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Affiliation(s)
- Andrey Manov
- Internal Medicine, MountainView Hospital, Las Vegas, USA
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8
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Chong GY, Kaur S, Ruzita AT, Wilfred Mok KH, Tan HY, Loy SL, Chen LW, Siah WY, Lim GP, Chee YY, June Lem EM, Koo HC. Scoping review: Exploring the relationship between chrononutrition and glycemic responses in the adult population. Chronobiol Int 2024; 41:904-923. [PMID: 38832541 DOI: 10.1080/07420528.2024.2360742] [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: 09/28/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024]
Abstract
Chrononutrition, an emerging body of evidence on the relationship between biological rhythms and metabolism, has been established to be associated with glycemic responses. However, the available evidence is inconsistent, due to protocol variations. Therefore, this review aims to summarize the findings on chrononutrition characteristics and their association with glycemic responses among adults. Systematic searches were conducted across six databases (PubMed, EBSCO Host, ProQuest Central, MEDLINE & Ovid, Scopus and Web of Science) to identify all relevant studies published from January 2012. Two reviewers independently screened the abstracts and full-text articles based on the inclusion and exclusion criteria. Details about population characteristics, study methods and key findings were extracted following the PRISMA-ScR guideline. The quality of selected studies was evaluated using the mixed methods appraisal tool. The searchers identified 49 studies eligible for analysis. The results showed that meal timing, particularly night-time eating and snacking were associated with glycemic responses. Regarding meal regularity, skipping breakfast may affect glycemic responses, but no clear conclusion was drawn about its effect on insulin. The association between meal frequency and glycemic responses was inconclusive. Night fasting duration and restricted eating window are potentially associated with glycemic responses. The current review extensively investigates the association between chrononutrition factors and glycemic responses in adults. However, more prospective cohort and interventional studies are needed to better understand this causal-effect relationship.
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Affiliation(s)
- Guey Yong Chong
- Faculty of Applied Sciences, Tunku Abdul Rahman University of Management and Technology, Kuala Lumpur, Malaysia
| | - Satvinder Kaur
- Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Abd Talib Ruzita
- Nutritional Sciences Program, Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Kok Hoe Wilfred Mok
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Hui Yin Tan
- Faculty of Applied Sciences, Tunku Abdul Rahman University of Management and Technology, Kuala Lumpur, Malaysia
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Obstetrics & Gynecology Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Ling-Wei Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Master of Public Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Woan Yie Siah
- Klinik Kesihatan Batu Berendam, Pejabat Kesihatan Daerah Melaka Tengah, Melaka, Malaysia
| | - Geok Pei Lim
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Yin Yin Chee
- Faculty of Applied Sciences, Tunku Abdul Rahman University of Management and Technology, Kuala Lumpur, Malaysia
| | - Ee Mun June Lem
- Faculty of Applied Sciences, Tunku Abdul Rahman University of Management and Technology, Kuala Lumpur, Malaysia
| | - Hui Chin Koo
- Faculty of Applied Sciences, Tunku Abdul Rahman University of Management and Technology, Kuala Lumpur, Malaysia
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Ibrahim M, Ba-Essa E, Alarouj M, Annabi F, Armstrong DG, Bennakhi A, Ceriello A, Elbarbary N, Khochtali I, Karadeniz S, Naz Masood S, Mimouni S, Shaikh S, Tuomilehto J, Umpierrez GE. Recommendations for management of diabetes and its complications during Hajj (Muslim Pilgrimage) - 2024 update. Diabetes Res Clin Pract 2024; 212:111647. [PMID: 38569944 DOI: 10.1016/j.diabres.2024.111647] [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: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
Hajj is an obligatory duty for all healthy adult Muslims once in the lifetime subjected to the ability. Considering the 10.5 % global prevalence of diabetes coupled with the numbers of Muslims performing the Hajj, ∼ 1.8 million in 2023, it is estimated that Muslims with diabetes performing Hajj may exceed 340,000 this year. During Hajj the pattern and amount of their meal, fluid intake and physical activity are markedly altered. Many people with diabetes insist on doing the Hajj duty, thereby creating a medical challenge for themselves and their health care providers. It is therefore important that medical professionals be aware of the potential risks that may be associated with Hajj. People with diabetes may face many health hazards during Hajj including but not limited to the killer triad which might occur during Hajj: Hypoglycemia, Foot injury and Infections. Many precautions should be taken to prevent and treat these potentially serious complications. Risk stratification, medication adjustments, proper clinical assessment, and education before doing Hajj are crucial.
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Affiliation(s)
| | - Ebtesam Ba-Essa
- Consultant Internist and Endocrinologist, Alrawdah General hospital, Dammam, Saudi Arabia; Almani General Hospital, Dammam, Saudi Arabia
| | | | - Firas Annabi
- Consultant Internist, Endocrinologist, Program Director of Internal Medicine, Islamic Hospital Amman, Jordan
| | | | | | | | - Nancy Elbarbary
- Department of Pediatrics, Diabetes and Endocrinology Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ines Khochtali
- Department of Endocrinology, University Hospital of Monastir, Tunisia
| | | | | | | | | | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland; Diabetes Research Unit, King Abdulaziz University, Jeddah, Saudi Arabia
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Thapa A, Chibvunde S, Schwartz L, Trujillo C, Ferrari G, Drown L, Gomber A, Park PH, Matanje B, Msekandiana A, Kachimanga C, Bukhman G, Ruderman T, Adler AJ. Appropriateness and acceptability of continuous glucose monitoring in people with type 1 diabetes at rural first-level hospitals in Malawi: a qualitative study. BMJ Open 2024; 14:e075559. [PMID: 38719287 PMCID: PMC11086409 DOI: 10.1136/bmjopen-2023-075559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES The purpose of this qualitative study is to describe the acceptability and appropriateness of continuous glucose monitoring (CGM) in people living with type 1 diabetes (PLWT1D) at first-level (district) hospitals in Malawi. DESIGN We conducted semistructured qualitative interviews among PLWT1D and healthcare providers participating in the study. Standardised interview guides elicited perspectives on the appropriateness and acceptability of CGM use for PLWT1D and their providers, and provider perspectives on the effectiveness of CGM use in Malawi. Data were coded using Dedoose software and analysed using a thematic approach. SETTING First-level hospitals in Neno district, Malawi. PARTICIPANTS Participants were part of a randomised controlled trial focused on CGM at first-level hospitals in Neno district, Malawi. Pretrial and post-trial interviews were conducted for participants in the CGM and usual care arms, and one set of interviews was conducted with providers. RESULTS Eleven PLWT1D recruited for the CGM randomised controlled trial and five healthcare providers who provided care to participants with T1D were included. Nine PLWT1D were interviewed twice, two were interviewed once. Of the 11 participants with T1D, six were from the CGM arm and five were in usual care arm. Key themes emerged regarding the appropriateness and effectiveness of CGM use in lower resource setting. The four main themes were (a) patient provider relationship, (b) stigma and psychosocial support, (c) device usage and (d) clinical management. CONCLUSIONS Participants and healthcare providers reported that CGM use was appropriate and acceptable in the study setting, although the need to support it with health education sessions was highlighted. This research supports the use of CGM as a component of personalised diabetes treatment for PLWT1D in resource constraint settings. TRIAL REGISTRATION NUMBER PACTR202102832069874; Post-results.
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Affiliation(s)
- Ada Thapa
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Leah Schwartz
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Celina Trujillo
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Gina Ferrari
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Laura Drown
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Apoorva Gomber
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Paul H Park
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | - Gene Bukhman
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
- Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Alma J Adler
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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11
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Quah PL, Tan LK, Lek N, Tagore S, Chern BSM, Ang SB, Wright A, Thain SPT, Tan KH. Continuous Glucose Monitoring Feedback in the Subsequent Development of Gestational Diabetes: A Pilot, Randomized, Controlled Trial in Pregnant Women. Am J Perinatol 2024; 41:e3374-e3382. [PMID: 38242163 PMCID: PMC11156501 DOI: 10.1055/s-0043-1778664] [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: 09/27/2023] [Accepted: 10/22/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE This study evaluated the effects of receiving glucose feedback from continuous glucose monitoring (CGM) by intermittent scanning (unblinded group), and CGM with masked feedback (blinded group) in the subsequent development of gestational diabetes mellitus (GDM). STUDY DESIGN This was a prospective, single-center, pilot, randomized controlled trial including n = 206 pregnant women in the first trimester of pregnancy with no prior diagnosis of type 1 or type 2 diabetes. The participants were randomized into the unblinded group or blinded group and wore the CGM in the first trimester of pregnancy (9-13 weeks), the second trimester of pregnancy (18-23 weeks), and late-second to early-third trimester (24-31 weeks). The primary outcome was GDM rate as diagnosed by the 75-g oral glucose tolerance test (OGTT) at 24 to 28 weeks. RESULTS Over 47 months, 206 pregnant women were enrolled at 9 to 13 weeks. The unblinded group had a higher prevalence of women who developed GDM (21.5 vs. 14.9%; p > 0.05), compared to the blinded group. In the unblinded group compared to the blinded group, plasma glucose values were higher at 1 hour (median 7.7 [interquartile range {IQR}: 6.3-9.2] vs. 7.5 [6.3-8.7]) and 2 hours (6.3 [5.8-7.7] vs. 6.2 [5.3-7.2]), but lower at 0 hour (4.2 [4.0-4.5] vs. 4.3 [4.1-4.6]; p > 0.05). All these differences were not statistically significant. CONCLUSION Glucose feedback from CGM wear in the first to the third trimester of pregnancy without personalized patient education failed to alter GDM rate. KEY POINTS · Continuous glucose monitoring (CGM) is feasible for use in pregnant women.. · No significant difference in gestational diabetes rates with or without CGM feedback.. · Future clinical trials should incorporate CGM education and personalized guidance to enhance study outcomes..
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Affiliation(s)
- Phaik Ling Quah
- Division of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Lay Kok Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Ngee Lek
- Department of Pediatrics, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Shephali Tagore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | | | - Seng Bin Ang
- Family Medicine Service/Menopause Unit, KK Women's and Children's Hospital, Singapore
| | - Ann Wright
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Serene Pei Ting Thain
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Kok Hian Tan
- Division of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
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12
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Guldemond N. What is meant by 'integrated personalized diabetes management': A view into the future and what success should look like. Diabetes Obes Metab 2024; 26 Suppl 1:14-29. [PMID: 38328815 DOI: 10.1111/dom.15476] [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: 11/27/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/09/2024]
Abstract
Integrated personalized diabetes management (IPDM) has emerged as a promising approach to improving outcomes in patients with diabetes mellitus (DM). This care approach emphasizes the integration and coordination of different providers, including physicians, nurses, dietitians, social workers and pharmacists. The goal of IPDM is to provide patients with personalized care that is tailored to their needs. This review addresses the concept of integrated care and the use of technology (including data, software applications and artificial intelligence) as well as managerial, regulatory and financial aspects. The implementation and upscaling of digitally enabled IPDM are discussed, with elaboration of successful practices and related evidence. Finally, recommendations are made. It is concluded that the adoption of digitally enabled IPDM on a global level is inevitable, considering the challenges created by an increasing prevalence of patients with DM and the need for better outcomes and improvement of health system sustainability.
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Affiliation(s)
- Nick Guldemond
- Department of Public Health and Primary Care, Leiden Universitair Medisch Centrum, Leiden, Netherlands
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13
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Di Filippo D, Darling J, Chang MHY, Henry A, Welsh A. Oral glucose tolerance test and continuous glucose monitoring for gestational diabetes diagnosis: a survey study of women and health care professionals. Arch Gynecol Obstet 2024; 309:483-489. [PMID: 36739593 PMCID: PMC9899442 DOI: 10.1007/s00404-023-06949-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/24/2023] [Indexed: 02/06/2023]
Abstract
AIMS The oral glucose tolerance test (OGTT), used for gestational diabetes mellitus (GDM) diagnosis for over 65 years, has poor acceptability and tolerability. Continuous glucose monitoring is being considered as potential alternative. The aim of our study was to formally assess women's and health care professionals' perception of both tests as diagnostic tools for GDM. METHODS Participants in a pilot study on continuous glucose monitoring for GDM diagnosis were invited to fill two questionnaires, each of 6 Likert-scale and one optional open-ended question. A range of healthcare practitioners were also invited to fill a questionnaire of 13 Likert-scale and 7 optional open-ended questions. RESULTS Sixty women completed the OGTT and 70 the continuous glucose monitoring questionnaire. OGTT was reported as poorly acceptable. Continuous glucose monitoring was described as significantly more tolerable (81% vs 27% 5/5 general acceptability rate, p < 0.001); ninety-three percent of the participants would recommend it for GDM diagnosis. Thirty health care professionals completed the survey. Most of them (73%) had confidence in OGTT as a diagnostic test for GDM with 66% raising some concerns. Doubts on continuous glucose monitoring were raised in terms of costs, accessibility and accuracy for GDM diagnosis due to "lack of evidence". CONCLUSIONS Continuous glucose monitoring was substantially better tolerated for women than OGTT. Current lack of evidence for diagnostic accuracy for GDM underlines the need for studies on correlation between continuous glucose monitoring parameters and pregnancy outcomes to strengthen evidence for its use as diagnostic test for GDM.
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Affiliation(s)
- Daria Di Filippo
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Justine Darling
- Diabetes Clinic, Royal Hospital for Women, Sydney, NSW, Australia
| | - Melissa Han Yiin Chang
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Amanda Henry
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, NSW, Australia
| | - Alec Welsh
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Locked Bag 2000, Barker Street, SydneyRandwick, NSW, 2031, Australia.
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14
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Waibel FWA, Uçkay I, Soldevila-Boixader L, Sydler C, Gariani K. Current knowledge of morbidities and direct costs related to diabetic foot disorders: a literature review. Front Endocrinol (Lausanne) 2024; 14:1323315. [PMID: 38298183 PMCID: PMC10829909 DOI: 10.3389/fendo.2023.1323315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
Diabetes is a chronic disease associated with numerous complications including diabetic foot disorders, which are associated with significant morbidity and mortality as well as high costs. The costs associated with diabetic foot disorders comprise those linked to care (direct) and loss of productivity and poor quality of life (indirect). Due to the constant increase in diabetes prevalence, it is expected that diabetic foot disorder will require more resources, both in terms of caregivers and economically. We reviewed findings on management, morbidity, mortality, and costs related to diabetic foot disorder.
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Affiliation(s)
- Felix W. A. Waibel
- Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ilker Uçkay
- Infectiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Laura Soldevila-Boixader
- Infectious Diseases, Internal Medicine Department, Consorci Sanitari Integral-CSI, Sant Joan Despí Hospital, Barcelona, Spain
| | - Christina Sydler
- Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karim Gariani
- Service of Endocrinology, Diabetes, Nutrition, and Therapeutic Education, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Diabetes Center of the Faculty of Medicine, University of Geneva Medical School, Geneva, Switzerland
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15
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Lazar S, Ionita I, Reurean-Pintilei D, Timar B. How to Measure Glycemic Variability? A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:61. [PMID: 38256322 PMCID: PMC10818970 DOI: 10.3390/medicina60010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/17/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Optimal glycemic control without the presence of diabetes-related complications is the primary goal for adequate diabetes management. Recent studies have shown that hemoglobin A1c level cannot fully evaluate diabetes management as glycemic fluctuations are demonstrated to have a major impact on the occurrence of diabetes-related micro- and macroangiopathic comorbidities. The use of continuous glycemic monitoring systems allowed the quantification of glycemic fluctuations, providing valuable information about the patients' glycemic control through various indicators that evaluate the magnitude of glycemic fluctuations in different time intervals. This review highlights the significance of glycemic variability by describing and providing a better understanding of common and alternative indicators available for use in clinical practice.
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Affiliation(s)
- Sandra Lazar
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Hematology, Emergency Municipal Hospital Timisoara, 300041 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.R.-P.); (B.T.)
| | - Ioana Ionita
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Hematology, Emergency Municipal Hospital Timisoara, 300041 Timisoara, Romania
| | - Delia Reurean-Pintilei
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.R.-P.); (B.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases, Consultmed Medical Centre, 700544 Iasi, Romania
| | - Bogdan Timar
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.R.-P.); (B.T.)
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Diabetes, “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania
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16
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Abstract
Diabetes technology has undergone a remarkable evolution in the past decade, with dramatic improvements in accuracy and ease of use. Continuous glucose monitor (CGM) technology, in particular, has evolved, and coevolved with widely available consumer smartphone technology, to provide a unique opportunity to both improve management and decrease the burden of management for populations across nearly the entire spectrum of people living with diabetes. Capitalizing on that opportunity, however, will require both adoption of and adaptations to the use of CGM technology in the broader world of primary care. This article focuses on mechanisms to expand pathways to optimized glycemic management, thereby creating a robust roadway capable of improving care across broad populations managed in primary care settings. Recent expansions in access to devices combined with improved mechanisms for data access at the time of primary care visits and improved training and evolving systems of support within primary care, hold potential to improve glycemic management in diabetes across the health care spectrum.
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Affiliation(s)
- Thomas W. Martens
- International Diabetes Center and Park Nicollet Department of Internal Medicine, St. Louis Park, MN
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17
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Sun R, Duan Y, Zhang Y, Feng L, Ding B, Yan R, Ma J, Su X. Time in Range Estimation in Patients with Type 2 Diabetes is Improved by Incorporating Fasting and Postprandial Glucose Levels. Diabetes Ther 2023:10.1007/s13300-023-01432-2. [PMID: 37328714 PMCID: PMC10299970 DOI: 10.1007/s13300-023-01432-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Time in range (TIR) as assessed by continuous glucose monitoring (CGM) measures an individual's glucose fluctuations within set limits in a time period and is increasingly used together with HbA1c in patients with diabetes. HbA1c indicates the average glucose concentration but provides no information on glucose fluctuation. However, before CGM becomes available for patients with type 2 diabetes (T2D) worldwide, especially in developing nations, fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) are still the common biomarkers used for monitoring diabetes conditions. We investigated the importance of FPG and PPG to glucose fluctuation in patients with T2D. We used machine learning to provide a new estimate of TIR based on the HbA1c, together with FPG and PPG. METHODS This study included 399 patients with T2D. (1) Univariate and (2) multivariate linear regression models and (3) random forest regression models were developed to predict the TIR. Subgroup analysis was performed in the newly diagnosed T2D population to explore and optimize the prediction model for patients with different disease history. RESULTS Regression analysis suggests that FPG was strongly linked to minimum glucose, while PPG was strongly correlated with maximum glucose. After FPG and PPG were incorporated into the multivariate linear regression model, the prediction performance of TIR was improved compared with the univariate correlation between HbA1c and TIR, and the correlation coefficient (95% CI) increased from 0.62 (0.59, 0.65) to 0.73 (0.72, 0.75) (p < 0.001). The random forest model significantly outperformed the linear model (p < 0.001) in predicting TIR through FPG, PPG and HbA1c, with a stronger correlation coefficient 0.79 (0.79, 0.80). CONCLUSIONS The results offered a comprehensive understanding of glucose fluctuations through FPG and PPG compared to HbA1c alone. Our novel TIR prediction model based on random forest regression with FPG, PPG, and HbA1c provides a better prediction performance than the univariate model with solely HbA1c. The results indicate a nonlinear relationship between TIR and glycaemic parameters. Our results suggest that machine learning may have the potential to be used in developing better models for understanding patients' disease status and providing necessary interventions for glycaemic control.
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Affiliation(s)
- Rui Sun
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yanli Duan
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yumei Zhang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | | | - Bo Ding
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rengna Yan
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Xiaofei Su
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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18
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Sherrill CH, Lee S. Prevalence, characteristics, and health-related quality of life of continuous glucose monitoring use according to the Behavioral Risk Factor Surveillance System 2014-2020. J Manag Care Spec Pharm 2023; 29:541-549. [PMID: 37121248 PMCID: PMC10387903 DOI: 10.18553/jmcp.2023.29.5.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND: Continuous glucose monitoring (CGM) can improve behavioral and clinical outcomes. The use of CGM in real-world practice appears to be increasing. However, actual prevalence and characteristics of using CGM in real-world practice are unknown. OBJECTIVE: To investigate the prevalence of CGM use by American adults with diabetes mellitus and differences in demographics and health-related quality of life (HRQOL) between users of CGM and self-monitoring of blood glucose (SMBG). METHODS: This serial cross-sectional study using 2014-2020 Behavioral Risk Factor Surveillance System data included nonpregnant adults with self-reported diabetes using CGM or 4-15 times daily SMBG. Outcomes were prevalence of CGM use, demographics, and the 4-item Centers for Disease Control and Prevention HRQOL (CDC HRQOL-4). Unadjusted analysis was performed using univariable regression, and adjusted analysis was performed using nearest neighbor matching to compare CDC HRQOL-4 between SMBG and CGM groups in SAS Studio version 5.2. RESULTS: Among 12,053 included respondents, 231 (1.9%) reported using CGM, and prevalence increased from 0.4% in 2014 to 4.1% in 2020. Compared with SMBG users, CGM users were more likely to be younger (50.3 years vs 56.1 years; P < 0.001), employed (59.6% vs 30.6%; P = 0.001), earn at least $75,000/year (48.5% vs 22.0%, P < 0.001), have insurance coverage (99.7% vs 95.4%; P = 0.005), and report fewer comorbidities (history of myocardial infarction, stroke, arthritis, depressive disorder, and kidney disease; all P < 0.05). After nearest neighbor matching, diabetes management-related characteristics were shown to have statistically significant differences between CGM and SMBG users including: age at diabetes diagnosis (30.6 vs 35.6 years; P = 0.005), not seeing a doctor because of cost concern (2.6% vs 7.8%; P = 0.011), checking hemoglobin A1c biannually (91.3% vs 86.6%; P = 0.047), performing daily foot self-examination (58.9% vs 69.6%; P = 0.028), receiving foot examination by a health care professional annually (87.9% vs 93.5%; P = 0.048), and receiving a shingles vaccine in the past (16.5% vs 10.1%; P = 0.024). CDC HRQOL-4 were shown to be similar between the 2 groups across the 4 domains (general health, physical, mental, and combined physical and mental health). CONCLUSIONS: An increased trend in CGM use was observed from 2014 to 2020. Economic factors were associated with CGM use over SMBG, and CGM use did not show a difference in HRQOL measured across the 4 domains.
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Affiliation(s)
- Christina H Sherrill
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, NC
| | - Sun Lee
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, NC
- Analysis Group, Boston, MA
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19
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Cuevas H, Muñoz E, Nagireddy D, Kim J, Ganucheau G, Alomoush F. The Association of Glucose Variability and Dementia Incidence in Latinx Adults with Type 2 Diabetes: A Retrospective Study. Clin Nurs Res 2023; 32:249-255. [PMID: 36472225 DOI: 10.1177/10547738221141232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Latinx adults with both cognitive dysfunction and type 2 diabetes mellitus (T2DM) are significantly more likely than Latinx adults with diabetes alone to have complications such as cardiovascular disease. Glucose variability may be a risk for dementia, but the course of glucose variability in the time before a dementia diagnosis for Latinx adults with T2DM has not been examined. We used a 10-year retrospective cohort of medical records of Latinx patients with T2DM who had at least one use of a continuous glucose monitor. The objective was to examine how glucose variability was associated with future dementia diagnoses. A total of 116 charts were included. Mean of daily differences and mean amplitude of glycemic excursions were more strongly associated with dementia diagnoses than other variability indices (p < .01). Understanding the relationships between cognitive function, glucose variability, and barriers to health care can translate into improved interventions to enhance diabetes care.
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Affiliation(s)
- Heather Cuevas
- The University of Texas at Austin, School of Nursing, USA
| | - Elizabeth Muñoz
- The University of Texas at Austin, College of Natural Sciences, USA
| | - Divya Nagireddy
- The University of Texas at Austin, College of Natural Sciences, USA
| | - Jeeyeon Kim
- The University of Texas at Austin, School of Nursing, USA
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20
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The Impact of Diabetic Education on Diabetes Management: A Retrospective Chart Review. J Christ Nurs 2023; 40:42-47. [PMID: 36469876 DOI: 10.1097/cnj.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT Helping patients control diabetes mellitus (DM) and minimize complications is the top priority for care of patients with diabetes. A retrospective review of 86 charts was conducted to investigate the impact of an 8-hour diabetic education program on glycemic control and weight in adults with type 2 DM. Hemoglobin A1C levels and weights were documented pre- and postintervention. Patients participating in the program demonstrated decreased levels of mean A1C and mean weight postintervention. Spiritual care for people living with diabetes and the use of continuous glucose monitors to improve disease management are discussed.
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21
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Vrany EA, Hill-Briggs F, Ephraim PL, Myers AK, Garnica P, Fitzpatrick SL. Continuous glucose monitors and virtual care in high-risk, racial and ethnic minority populations: Toward promoting health equity. Front Endocrinol (Lausanne) 2023; 14:1083145. [PMID: 36761197 PMCID: PMC9905720 DOI: 10.3389/fendo.2023.1083145] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
Continuous glucose monitors (CGMs) have become an important tool to aid self-management of blood glucose for many patients with diabetes in the U.S., and the benefits of CGM use are well-documented. However, disparities in CGM use exist, with lower use in certain marginalized racial and ethnic groups. CGM may be an important and underutilized tool to help reduce inequities. Evidence supporting the use of CGMs as a part of virtual care is discussed, with an emphasis on designing virtual diabetes care programs to promote health equity. Recommendations for clinical practice and research are presented. In clinical practice, CGM should be an option for all people with diabetes who qualify based on clinical practice guidelines, regardless of race, ethnicity, or other individual characteristics. Future research should characterize the use of, benefit from, and preferences for CGM among individuals from racial and ethnic groups to guide interventions at the health system, clinic, provider, and patient levels to promote equitable, evidence-based, and guideline-directed CGM use in marginalized racial and ethnic groups with diabetes.
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Affiliation(s)
- Elizabeth A. Vrany
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- *Correspondence: Elizabeth A. Vrany,
| | - Felicia Hill-Briggs
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Patti L. Ephraim
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Alyson K. Myers
- Fleischer Institute for Diabetes and Metabolism, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Patricia Garnica
- Department of Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Stephanie L. Fitzpatrick
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
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22
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Bickel S, Morton R, Eid N. Digital Inhaler Technology: Is It Ready for Prime Time? PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2022; 35:111-113. [PMID: 36121782 DOI: 10.1089/ped.2022.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Scott Bickel
- Department of Pediatrics, Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Ronald Morton
- Department of Pediatrics, Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Nemr Eid
- Department of Pediatrics, Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky, USA
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23
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Rossi A, Venema A, Haarsma P, Feldbrugge L, Burghard R, Rodriguez-Buritica D, Parenti G, Oosterveer MH, Derks TGJ. A Prospective Study on Continuous Glucose Monitoring in Glycogen Storage Disease Type Ia: Toward Glycemic Targets. J Clin Endocrinol Metab 2022; 107:e3612-e3623. [PMID: 35786777 PMCID: PMC9387687 DOI: 10.1210/clinem/dgac411] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Although previous research has shown the benefit of continuous glucose monitoring (CGM) for hepatic glycogen storage diseases (GSDs), current lack of prospectively collected CGM metrics and glycemic targets for CGM-derived outcomes in the hepatic GSD population limits its use. OBJECTIVE To assess CGM metrics for glycemic variation and glycemic control in adult patients with GSDIa as compared to matched healthy volunteers. DESIGN Prospective CGM data were collected during the ENGLUPRO GSDIa trial (NCT04311307) in which a Dexcom G6 device was used. Ten adult patients with GSDIa and 10 age-, sex- and body mass index-matched healthy volunteers were enrolled. Capillary blood glucose was concurrently measured during 2 standardized 2-hour time intervals. Descriptive [eg, glycemic variability (GV), time below range, time in range (TIR), time above range (TAR)] and advanced (ie, first- and second-order derivatives, Fourier analysis) CGM outcomes were calculated. For each descriptive CGM outcome measure, 95% CIs were computed in patients with GSDIa and healthy volunteers, respectively. RESULTS CGM overestimation was higher under preprandial and level 1 hypoglycemia (ie, capillary glucose values ≥ 3.0 mmol/L and < 3.9 mmol/L) conditions. GV and TAR were higher while TIR was lower in patients with GSDIa compared to healthy volunteers (P < 0.05). Three patients with GSDIa showed descriptive CGM outcomes outside the calculated 95% CI in GSDIa patients. Advanced CGM analysis revealed a distinct pattern (ie, first- and second-order derivatives and glucose curve amplitude) in each of these 3 patients within the patients group. CONCLUSIONS This is the first study to prospectively compare CGM outcomes between adult patients with GSDIa and matched healthy volunteers. The generation of a set of CGM metrics will provide guidance in using and interpreting CGM data in GSDIa and will be useful for the definition of glycemic targets for CGM in patients with GSDIa. Future studies should investigate the prognostic value of CGM outcomes and their major determinants in patients with GSDIa.
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Affiliation(s)
- Alessandro Rossi
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Translational Medicine, Section of Pediatrics, University of Naples “Federico II,”Naples, Italy
| | - Annieke Venema
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Petra Haarsma
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - David Rodriguez-Buritica
- Division of Medical Genetics, Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX,USA
| | - Giancarlo Parenti
- Department of Translational Medicine, Section of Pediatrics, University of Naples “Federico II,”Naples, Italy
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
| | - Maaike H Oosterveer
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Terry G J Derks
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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24
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Dorcely B, Sifonte E, Popp C, Divakaran A, Katz K, Musleh S, Jagannathan R, Curran M, Sevick MA, Aleman JO, Goldberg IJ, Bergman M. Continuous glucose monitoring and 1-h plasma glucose identifies glycemic variability and dysglycemia in high-risk individuals with HbA1c < 5.7%: a pilot study. Endocrine 2022; 77:403-407. [PMID: 35729471 PMCID: PMC9212201 DOI: 10.1007/s12020-022-03109-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/05/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Brenda Dorcely
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA.
| | - Eliud Sifonte
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Collin Popp
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Anjana Divakaran
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Karin Katz
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Sarah Musleh
- Department of Endocrinology, Diabetes & Metabolism and Internal Medicine, Hawaii Permanente Medical Group, Honolulu, HI, 96814, USA
| | - Ram Jagannathan
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Margaret Curran
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Mary Ann Sevick
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - José O Aleman
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Ira J Goldberg
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Michael Bergman
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10016, USA
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Dabbagh Z, McKee MD, Pirraglia PA, Clements KM, Liu F, Amante DJ, Shukla P, Gerber BS. The Expanding Use of Continuous Glucose Monitoring in Type 2 Diabetes. Diabetes Technol Ther 2022; 24:510-515. [PMID: 35231190 DOI: 10.1089/dia.2021.0536] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Zakery Dabbagh
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - M Diane McKee
- Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Paul A Pirraglia
- Division of General Medicine and Community Health, UMass Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Karen M Clements
- Commonwealth Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Feifan Liu
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Daniel J Amante
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Prateek Shukla
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Ben S Gerber
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
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Urakami T, Terada H, Yoshida K, Kuwabara R, Mine Y, Aoki M, Shoji Y, Suzuki J, Morioka I. Comparison of the clinical effects of intermittently scanned and real-time continuous glucose monitoring in children and adolescents with type 1 diabetes: A retrospective cohort study. J Diabetes Investig 2022; 13:1745-1752. [PMID: 35532954 PMCID: PMC9533045 DOI: 10.1111/jdi.13830] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/16/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022] Open
Abstract
AIMS /Introduction The aim of the study was to compare two continuous glucose monitoring (CGM) systems, intermittently scanned CGM (isCGM) and real-time CGM (rtCGM), to determine which system achieved better glycemic control in pediatric patients. MATERIALS AND METHODS We conducted a retrospective cohort study of children and adolescents with type 1 diabetes and compared the time in range (TIR) (70-180 mg/dL), time below range (TBR) (< 70 mg/dL), and time above range (TAR) (> 180 mg/dL), and estimated HbA1c (eA1c) levels between patients on isCGM and rtCGM. RESULTS Of the 112 participants, 76 (67.9%) used isCGM and 36 (32.1%) used rtCGM for glycemic management. Patients on rtCGM had significantly greater TIR (57.7% ± 12.3% vs. 52.3% ± 12.3%, P = 0.0368), and had significantly lower TBR (4.3% ± 2.7% vs. 10.2% ± 5.4%, P < 0.001) than those on isCGM but there was no significant difference in the TAR (37.4% ± 12.9% vs. 38.0% ± 12.5%, P = 0.881) or the eA1c levels (7.4% ± 0.9% vs. 7.5% ± 0.8%, P = 0.734) between the two groups. CONCLUSIONS Pediatric patients with type 1 diabetes on rtCGM also showed more beneficial effects for increase of TIR with notably reduction of TBR than those on isCGM. Real-time CGM may provide better glycemic control than isCGM in children with type 1 diabetes.
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Affiliation(s)
- Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroki Terada
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Kei Yoshida
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Remi Kuwabara
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Yusuke Mine
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Masako Aoki
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuko Shoji
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Junichi Suzuki
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Ichiro Morioka
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
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27
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Urakami T, Yoshida K, Kuwabara R, Mine Y, Aoki M, Suzuki J, Morioka I. Frequent scanning using flash glucose monitoring contributes to better glycemic control in children and adolescents with type 1 diabetes. J Diabetes Investig 2022; 13:185-190. [PMID: 34143544 PMCID: PMC8756333 DOI: 10.1111/jdi.13618] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS/INTRODUCTION We examined the impact of scanning frequency with flash glucose monitoring on glycemic control in children and adolescents with type 1 diabetes. MATERIALS AND METHODS The study included 85 patients, aged 14.0 ± 0.5 years, with type 1 diabetes. The median time in the target glucose range (TIR) and glycosylated hemoglobin (HbA1c) values were 50.0 ± 1.4% and 7.5 ± 0.1%, respectively. RESULTS The median scanning frequency using flash glucose monitoring was 12.0 ± 0.4 times/day. Scanning frequency showed a significant positive correlation with TIR and an inverse correlation with HbA1c. Scanning frequency was identified to be the determinant of TIR and HbA1c by using multivariate analysis. The participants whose scanning frequency was <12 times/day were categorized as the low-frequency group (n = 40), and those who carried out the scanning >12 times/day were categorized as the high-frequency group (n = 45). Patients in the high-frequency group were more likely to be treated with insulin pumps compared with those in the low-frequency group; however, this difference was not significant (21.3 vs 5.3%, P = 0.073). The high-frequency group showed significantly greater TIR than the low-frequency group (57 ± 1.6 vs 42 ± 1.7%, P = 0.002). Furthermore, the high-frequency group showed significantly lower HbA1c levels than the low-frequency group (6.8 ± 0.1 vs 8.0 ± 0.1%, P < 0.001). CONCLUSIONS These findings showed that patients with a higher scanning frequency had better glycemic control, with greater TIRs and lower HbA1c levels, compared with those with a lower scanning frequency. Scanning frequency of >12 times/day might contribute to better glycemic outcomes in real-world practice in children with type 1 diabetes.
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Affiliation(s)
- Tatsuhiko Urakami
- Department of PediatricsNihon University School of MedicineTokyoJapan
| | - Kei Yoshida
- Department of PediatricsNihon University School of MedicineTokyoJapan
| | - Remi Kuwabara
- Department of PediatricsNihon University School of MedicineTokyoJapan
| | - Yusuke Mine
- Department of PediatricsNihon University School of MedicineTokyoJapan
| | - Masako Aoki
- Department of PediatricsNihon University School of MedicineTokyoJapan
| | - Junichi Suzuki
- Department of PediatricsNihon University School of MedicineTokyoJapan
| | - Ichiro Morioka
- Department of PediatricsNihon University School of MedicineTokyoJapan
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28
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Bailey TS, Alva S. Landscape of Continuous Glucose Monitoring (CGM) and Integrated CGM: Accuracy Considerations. Diabetes Technol Ther 2021; 23:S5-S11. [PMID: 34546084 DOI: 10.1089/dia.2021.0236] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Continuous glucose monitoring devices have significantly improved in many respects compared with earlier versions. As sensor accuracy improved, U.S. Food and Drug Administration approved a nonadjunctive indication for use that no longer required confirmatory blood glucose monitoring. This article discusses the performance characteristics and regulatory classifications for the current systems that are relevant to informed clinical decision-making.
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Frank JR, Blissett D, Hellmund R, Virdi N. Budget Impact of the Flash Continuous Glucose Monitoring System in Medicaid Diabetes Beneficiaries Treated with Intensive Insulin Therapy. Diabetes Technol Ther 2021; 23:S36-S44. [PMID: 34546079 DOI: 10.1089/dia.2021.0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: We assessed the economic impact of using the newest flash continuous glucose monitoring (CGM) among Medicaid beneficiaries with diabetes treated with intensive insulin therapy (IIT). Research Design and Methods: A budget impact analysis was created to assess the impact of increasing the proportion of Medicaid beneficiaries with diabetes on IIT, who use flash CGM by 10%. The analysis included glucose monitoring device costs, cost savings due to reductions in glycated hemoglobin, severe hypoglycemia events, and hyperglycemic emergencies such as diabetic ketoacidosis. The net change in costs per person to adopt flash CGM for three populations treated with IIT (adults with type 1 diabetes [T1D] or type 2 diabetes [T2D], and children and adolescents with T1D or T2D) was calculated; these costs were used to estimate the impact of increasing flash CGM use by 10% to the U.S. Medicaid budget over 1-3 years. Results: The analysis found that flash CGM demonstrated cost savings in all populations on a per patient basis. Increasing use of flash CGM by 10% was associated with a $19.4 million overall decrease in costs over the year and continued to reduce costs by $25.3 million in years 2 and 3. Conclusions: Our results suggest that the new flash CGM system can offer cost savings compared to blood glucose monitoring in Medicaid beneficiaries treated with IIT, especially T1D adults, and children and adolescents. These findings support expanding access to CGM by Medicaid plans.
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Murray-Bachmann R, Leung TM, Myers AK, Murthi S, Sarbanes M, Ziskovich K, Lesser M, Poretsky L. Reliability of continuous glucose monitoring system in the inpatient setting. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2021; 25:100262. [PMID: 34336598 PMCID: PMC8318984 DOI: 10.1016/j.jcte.2021.100262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/09/2021] [Accepted: 07/04/2021] [Indexed: 01/18/2023]
Abstract
Aims/Hypothesis Hyperglycemia and hypoglycemia are associated with increased morbidity and mortality in the inpatient setting. Standard point of care capillary glucose testing (POCT) is commonly used in hospitalized patients to monitor their glucose levels. The goal of this study was to examine the relationships between the glucose readings obtained by a continuous glucose monitoring system (CGMS) (Freestyle Libre) and the capillary blood glucose results obtained by the inpatient glucose POCT meter (Accuchek Inform II) as well as between CGMS readings and the serum glucose values obtained by the hospital laboratory. Study participants had either primary or secondary diagnosis of diabetes mellitus and were admitted to non-critical units. We hypothesized that there exists an acceptable agreement between the capillary blood glucose results obtained by the inpatient glucose POCT meter (Accuchek Inform II) and the readings obtained by the CGMS (Freestyle Libre); and that there exists an acceptable agreement between the serum glucose levels and the glucose values obtained by the CGMS. Methods This was an Institutional Review Board approved prospective cohort study for the non– critical inpatient setting. Fifty-two hospitalized patients with diabetes were recruited. After informed consent was obtained, patients were instructed on the application and use of the CGMS. The data were assessed using a standard regression analysis and modified Bland Altman analysis. All analyses were conducted using SAS, release 3.8 Enterprise Edition (SAS Institute Inc., Cary, NC). Results Fifty-two subjects recruited into the study represented a sample of convenience. There were a total of 467 AccuChek-Libre pairs, The regression analysis showed a negative bias between. Libre and AccuChek, R2 = 0.83, with Libre glucose readings on average being lower than those of AccuChek. Using Bland-Altman analysis, 42% of the 467 Libre-AccuChek pairs had a difference in glucose reading more than 15%. Mean absolute relative difference (MARD) between Libre and AccuChek was 15.6%; mean relative difference (MRD) between Libre and AccuChek was −11.4%. The regression analysis showed a negative bias between Libre and serum glucose, R2 = 0.89. Using Bland Altman analysis, 36% of the 44 Libre-serum pairs had a difference in glucose reading more than 15%. Mean absolute relative difference (MARD) between Libre and serum glucose was 13.2%; mean relative difference (MRD) between Libre and serum glucose was −12.5%. A review of the data pairs showed that 71/467 Accuchek-Libre pairs had one result that was either below 70 mg/dl or above 200 mg/dl (combined American Diabetes Association-ADA-, American College of Physicians-ACP- and American College of Endocrinology-AACE- goals). Thus 85%, of these pairs would have yielded results that engendered the same intervention (e.g. treatment for hypoglycemia or hyperglycemia). Likewise 5/45 Serum-Libre pairs had one result that was either below 70 mg/dl or above 200 mg/dl; thus 89% of these pairs would have yielded results requiring the same intervention. Conclusion/Interpretation These findings confirm the existent literature and indicate acceptable agreement between the standard POCT and the CGMS as well as between serum glucose and the CGMS values. Because of the advantages of the CGMS over capillary blood glucose testing (reduced patient discomfort and reduced staff exposure to patients in isolation) CGMS use may be preferable to the current bedside capillary blood glucose testing in hospitalized patients with diabetes mellitus. As with other laboratory measures, clinical judgement needs to be exercised when the laboratory values are used to guide patient care.
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Affiliation(s)
| | - Tung Ming Leung
- Biostatistics Unit - Feinstein Institutes for Medical Research, Northwell Health, Great Neck, New York, USA
| | - Alyson K Myers
- Department of Medicine, Division of Endocrinology, North Shore University Hospital, Manhasset, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Center for Health Innovations and Outcomes Research, Northwell Health, Manhasset, New York, USA
| | - Swetha Murthi
- Division of Endocrinology, Friedman Diabetes Institute Department of Medicine, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Mulugeta Sarbanes
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Karina Ziskovich
- Division of Endocrinology, Friedman Diabetes Institute Department of Medicine, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Martin Lesser
- Biostatistics Unit - Feinstein Institutes for Medical Research, Northwell Health, Great Neck, New York, USA
| | - Leonid Poretsky
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Division of Endocrinology, Friedman Diabetes Institute Department of Medicine, Lenox Hill Hospital, Northwell Health, New York, New York, USA
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