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Schoelwer MJ, DeBoer MD, Breton MD. Use of diabetes technology in children. Diabetologia 2024; 67:2075-2084. [PMID: 38995398 PMCID: PMC11457698 DOI: 10.1007/s00125-024-06218-0] [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: 03/19/2024] [Accepted: 05/23/2024] [Indexed: 07/13/2024]
Abstract
Children with type 1 diabetes and their caregivers face numerous challenges navigating the unpredictability of this complex disease. Although the burden of managing diabetes remains significant, new technology has eased some of the load and allowed children with type 1 diabetes to achieve tighter glycaemic management without fear of excess hypoglycaemia. Continuous glucose monitor use alone improves outcomes and is considered standard of care for paediatric type 1 diabetes management. Similarly, automated insulin delivery (AID) systems have proven to be safe and effective for children as young as 2 years of age. AID use improves not only blood glucose levels but also quality of life for children with type 1 diabetes and their caregivers and should be strongly considered for all youth with type 1 diabetes if available and affordable. Here, we review key data on the use of diabetes technology in the paediatric population and discuss management issues unique to children and adolescents.
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Affiliation(s)
| | - Mark D DeBoer
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Marc D Breton
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
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2
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Weisman A. Getting Diabetes Technologies into the Hands of Those Who Need Them Most. NEJM EVIDENCE 2024; 3:EVIDe2400283. [PMID: 39315869 DOI: 10.1056/evide2400283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Affiliation(s)
- Alanna Weisman
- Department of Medicine, University of Toronto, Toronto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Health, Toronto
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3
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Patel PM, Thomas D, Liu Z, Aldrich-Renner S, Clemons M, Patel BV. Systematic review of disparities in continuous glucose monitoring and insulin pump utilization in the United States: Key themes and evidentiary gaps. Diabetes Obes Metab 2024; 26:4293-4301. [PMID: 39010293 DOI: 10.1111/dom.15774] [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: 05/13/2024] [Revised: 06/14/2024] [Accepted: 06/23/2024] [Indexed: 07/17/2024]
Abstract
AIM This study aims to provide a comprehensive overview of real-world evidence pertaining to disparities in the utilization of continuous glucose monitors (CGMs)/insulin pumps to highlight potential evidentiary gaps and discern emerging themes from the literature. MATERIALS AND METHODS A systematic review of published manuscripts and abstracts was conducted from: MEDLINE, EMBASE, Nursing and Allied Health, Web of Science and CINHAL. Attributes related to patients, outcomes, interventions (CGMs/pumps/both) and study type were captured. In addition, factors associated with disparities in device utilization were examined. RESULTS Thirty-six studies were included in the final analysis; the studies predominantly focused on people living with type 1 diabetes. Only two studies included individuals with type 2 diabetes. Almost two-thirds of the studies reported outcomes associated with disparities (e.g. glycated haemoglobin, diabetic ketoacidosis, resource utilization). Most studies highlighted disparities across race, ethnicity and insurance type. Evidentiary gaps were identified, particularly in the evidence for people with type 2 diabetes, the continuation of CGM/pump use and limited studies addressing disparities among Native Americans/American Indians. CONCLUSION This study reveals critical disparities in diabetes technology use across race, ethnicity and insurance type, particularly among people with type 1 diabetes. Evidentiary gaps assessing disparities in diabetes technology use persist, particularly concerning people with type 2 diabetes, Native American/American Indian and LGBTQ+ populations, and in outcomes related to continuation of use. Social and digital determinants of health, such as income, transportation, residential location and technological literacy, are crucial to achieving equitable access. Future research should focus on the patient journey to identify opportunities for equitable access to diabetes technology as its use grows.
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Affiliation(s)
- Pranav M Patel
- University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio, USA
| | - Divya Thomas
- University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio, USA
| | - Zhixi Liu
- University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio, USA
| | - Sarah Aldrich-Renner
- University of Toledo General Internal Medicine Clinic and College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio, USA
| | - Marilee Clemons
- University of Toledo General Internal Medicine Clinic and College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio, USA
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Walker AF, Haller MJ, Addala A, Filipp SL, Lal R, Gurka MJ, Figg LE, Hechavarria M, Zaharieva DP, Malden KG, Hood KK, Westen SC, Wong JJ, Donahoo WT, Basina M, Bernier AV, Duncan P, Maahs DM. Not all healthcare inequities in diabetes are equal: a comparison of two medically underserved cohorts. BMJ Open Diabetes Res Care 2024; 12:e004229. [PMID: 39242122 PMCID: PMC11381725 DOI: 10.1136/bmjdrc-2024-004229] [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: 03/28/2024] [Accepted: 08/15/2024] [Indexed: 09/09/2024] Open
Abstract
INTRODUCTION Diabetes disparities exist based on socioeconomic status, race, and ethnicity. The aim of this study is to compare two cohorts with diabetes from California and Florida to better elucidate how health outcomes are stratified within underserved communities according to state location, race, and ethnicity. RESEARCH DESIGN AND METHODS Two cohorts were recruited for comparison from 20 Federally Qualified Health Centers as part of a larger ECHO Diabetes program. Participant-level data included surveys and HbA1c collection. Center-level data included Healthcare Effectiveness Data and Information Set metrics. Demographic characteristics were summarized overall and stratified by state (frequencies, percentages, means (95% CIs)). Generalized linear mixed models were used to compute and compare model-estimated rates and means. RESULTS Participant-level cohort: 582 adults with diabetes were recruited (33.0% type 1 diabetes (T1D), 67.0% type 2 diabetes (T2D)). Mean age was 51.1 years (95% CI 49.5, 52.6); 80.7% publicly insured or uninsured; 43.7% non-Hispanic white (NHW), 31.6% Hispanic, 7.9% non-Hispanic black (NHB) and 16.8% other. Center-level cohort: 32 796 adults with diabetes were represented (3.4% with T1D, 96.6% with T2D; 72.7% publicly insured or uninsured). Florida had higher rates of uninsured (p<0.0001), lower continuous glucose monitor (CGM) use (18.3% Florida; 35.9% California, p<0.0001), and pump use (10.2% Florida; 26.5% California, p<0.0001), and higher proportions of people with T1D/T2D>9% HbA1c (p<0.001). Risk was stratified within states with NHB participants having higher HbA1c (mean 9.5 (95% CI 8.9, 10.0) compared with NHW with a mean of 8.4 (95% CI 7.8, 9.0), p=0.0058), lower pump use (p=0.0426) and CGM use (p=0.0192). People who prefer to speak English were more likely to use a CGM (p=0.0386). CONCLUSIONS Characteristics of medically underserved communities with diabetes vary by state and by race and ethnicity. Florida's lack of Medicaid expansion could be a factor in worsened risks for vulnerable communities with diabetes.
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Affiliation(s)
- Ashby F Walker
- University of Florida Diabetes Institute, Gainesville, Florida, USA
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
| | - Michael J Haller
- University of Florida Diabetes Institute, Gainesville, Florida, USA
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Ananta Addala
- Stanford Diabetes Research Center, Stanford, California, USA
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Stephanie L Filipp
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Rayhan Lal
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Matthew J Gurka
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Lauren E Figg
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Keilecia G Malden
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Korey K Hood
- Stanford Diabetes Research Center, Stanford, California, USA
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Sarah C Westen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Jessie J Wong
- Stanford Diabetes Research Center, Stanford, California, USA
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - William T Donahoo
- University of Florida Diabetes Institute, Gainesville, Florida, USA
- Division of Endocrinology, Diabetes, & Metabolism, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Marina Basina
- Stanford Diabetes Research Center, Stanford, California, USA
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Angelina V Bernier
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Paul Duncan
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
| | - David M Maahs
- Stanford Diabetes Research Center, Stanford, California, USA
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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van den Boom L, Auzanneau M, Woelfle J, Sindichakis M, Herbst A, Meraner D, Hake K, Klinkert C, Gohlke B, Holl RW. Use of Continuous Glucose Monitoring in Pump Therapy Sensor Augmented Pump or Automated Insulin Delivery in Different Age Groups (0.5 to <26 Years) With Type 1 Diabetes From 2018 to 2021: Analysis of the German/Austrian/Swiss/Luxemburg Diabetes Prospective Follow-up Database Registry. J Diabetes Sci Technol 2024; 18:1122-1131. [PMID: 36840616 PMCID: PMC11418416 DOI: 10.1177/19322968231156601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
AIM Insulin pump, continuous glucose monitoring (CGM), and sensor augmented pump (SAP) technology have evolved continuously leading to the development of automated insulin delivery (AID) systems. Evaluation of the use of diabetes technologies in people with T1D from January 2018 to December 2021. METHODS A patient registry (Diabetes Prospective Follow-up Database [DPV]) was analyzed for use of SAP (insulin pump + CGM ≥90 days, no automated dose adjustment) and AID (HCL or LGS/PLGS). In total 46,043 people with T1D aged 0.5 to <26 years treated in 416 diabetes centers (Germany, Austria, Luxemburg, and Switzerland) were included and stratified into 4 groups A-D according to age. Additionally, TiR and HbA1c were analyzed. RESULTS From 2018 to 2021, there was a significant increase from 28.7% to 32.9% (sensor augmented pump [SAP]) and 3.5% to 16.6% (AID) across all age groups, with the most frequent use in group A (<7 years, 38.8%-40.2% and 10.3%-28.5%). A similar increase in SAP and AID use was observed in groups B (7 to <11 years) and C (11 to <16 years): B: +15.8 PP, C: +15.9 PP. HbA1c improved significantly in groups C and D (16 to <26 years) (both P < .01). Time in range (TiR) increased in all groups (A: +3 PP; B: +5 PP; C: +5 PP; D: +5 PP; P < 0.01 for each group). Insulin pumps (61.0% versus 53.4% male) and SAP (33.5% versus 28.9% male) are used more frequently in females. CONCLUSION In recent years, we found an increasing use of new diabetes technologies and an improvement in metabolic control (TiR) across all age groups.
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Affiliation(s)
- Louisa van den Boom
- Division of Pediatrics/Pediatric Diabetology, DRK Hospital, Kirchen, Germany
- Division of Pediatric Diabetology, Endocrinology, Metabolism and Obesity, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Marie Auzanneau
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Joachim Woelfle
- Children’s and Adolescent’s Hospital, University of Erlangen, Erlangen, Germany
| | | | - Antje Herbst
- Centre for Paediatrics, Medical Clinic Leverkusen, Leverkusen, Germany
| | - Dagmar Meraner
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Hake
- Children’s Hospital, Müritzklinikum Waren, Waren, Germany
| | | | - Bettina Gohlke
- Division of Pediatric Diabetology, Endocrinology, Metabolism and Obesity, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
- German Center for Diabetes Research, Neuherberg, Germany
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Lever CS, Williman JA, Boucsein A, Watson A, Sampson RS, Sergel-Stringer OT, Keesing C, Chepulis L, Wheeler BJ, de Bock MI, Paul RG. Real time continuous glucose monitoring in high-risk people with insulin-requiring type 2 diabetes: A randomised controlled trial. Diabet Med 2024; 41:e15348. [PMID: 38758653 DOI: 10.1111/dme.15348] [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: 03/18/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/19/2024]
Abstract
AIMS To investigate the impact of real-time continuous glucose monitoring (rtCGM) on glycaemia in a predominantly indigenous (Māori) population of adults with insulin-requiring type 2 diabetes (T2D) in New Zealand. METHODS Twelve-week, multicentre randomised controlled trial (RCT) of adults with T2D using ≥0.2 units/kg/day of insulin and elevated glycated haemoglobin (HbA1c) ≥64 mmol/mol (8.0%). Following a 2-week blinded CGM run-in phase, participants were randomised to rtCGM or control (self-monitoring blood glucose [SMBG]). The primary outcome was time in the target glucose range (3.9-10 mmol/L; TIR) during weeks 10-12, with data collected by blinded rtCGM in the control group. RESULTS Sixty-seven participants entered the RCT phase (54% Māori, 57% female), median age 53 (range 16-70 years), HbA1c 85 (IQR 74, 94) mmol/mol (9.9 [IQR 8.9, 10.8]%), body mass index (36.7 ± 7.7 kg/m2). Mean (±SD) TIR increased from 37 (24)% to 53 (24)% [Δ 13%; 95% CI 4.2 to 22; P = 0.007] in the rtCGM group but did not change in the SMBG group [45 (21)% to 45 (25)%, Δ 2.5%, 95% CI -6.1 to 11, P = 0.84]. Baseline-adjusted between-group difference in TIR was 10.4% [95% CI -0.9 to 21.7; P = 0.070]. Mean HbA1c (±SD) decreased in both groups from 85 (18) mmol/mol (10.0 [1.7]%) to 64 (16) mmol/mol (8.0 [1.4]%) in the rtCGM arm and from 81 (12) mmol/mol (9.6 [1.1]%) to 65 (13) mmol/mol (8.1 [1.2]%) in the SMBG arm (P < 0.001 for both). There were no severe hypoglycaemic or ketoacidosis events in either group. CONCLUSIONS Real-time CGM use in a supportive treat-to-target model of care likely improves glycaemia in a population with insulin-treated T2D and elevated HbA1c.
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Affiliation(s)
- Claire S Lever
- Te Huataki Waiora, School of Health, University of Waikato, Hamilton, New Zealand
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
| | - Jonathan A Williman
- Biostatistics and Computation Biology Unit, University of Otago, Christchurch, New Zealand
| | - Alisa Boucsein
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Antony Watson
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Rachael S Sampson
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
| | - Oscar T Sergel-Stringer
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Celeste Keesing
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
- Pinnacle Midlands Health Network, New Zealand
| | - Lynne Chepulis
- Te Huataki Waiora, School of Health, University of Waikato, Hamilton, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Paediatrics, Te Whatu Ora Southern, Dunedin, New Zealand
| | - Martin I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Te Whatu Ora Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Ryan G Paul
- Te Huataki Waiora, School of Health, University of Waikato, Hamilton, New Zealand
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
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Romeo GR, Caputo T, Stanescu IW, Alkhaddo JB. The Arduous Path Toward Equitable Access to Endocrinology Care. J Endocr Soc 2024; 8:bvae134. [PMID: 39071475 PMCID: PMC11273240 DOI: 10.1210/jendso/bvae134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Indexed: 07/30/2024] Open
Abstract
Multiple factors contribute to the widening gap between supply and demand of endocrinology services. In addition to the inadequate growth of the workforce, the inefficient utilization of endocrinologists' expertise coupled with the rising prevalence of endocrine conditions has generated a crisis in access to specialty care. This mismatch is magnified in underserved communities and among certain racial/ethnic groups that carry a disproportionate burden of chronic diseases, like diabetes and osteoporosis, thus perpetuating the cycle of health disparities in vulnerable populations. Reorienting the framework of endocrine care toward more effective and equitable access will require comprehensive changes in operational processes, system-based policies, and in the diversity of our workforce. Specifically, the progressive transition to outcome-driven, team-based models of care can extend endocrinology services beyond the traditional boundaries of in-office referrals and promote job satisfaction. Further, the implementation of policies that directly tackle structural determinants of health is a prerequisite to a more precise and equitable deployment of specialty care. In this view, the recruitment and professional growth of clinicians underrepresented in medicine along the career ladder, including leadership roles, is a key conduit to revitalize our field and to innovate the delivery of endocrine care across all communities.
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Affiliation(s)
- Giulio R Romeo
- Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
- Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Tiziana Caputo
- Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
| | - Izabela W Stanescu
- Ambulatory Operation Services, Mass General Brigham, Harvard Medical School, Boston, MA 02215, USA
| | - Jamil B Alkhaddo
- Division of Endocrinology, Department of Medicine, Allegheny Health Network, Pittsburgh, PA 15212, USA
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8
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Ni K, Tampe CA, Sol K, Cervantes L, Pereira RI. Continuous Glucose Monitor: Reclaiming Type 2 Diabetes Self-efficacy and Mitigating Disparities. J Endocr Soc 2024; 8:bvae125. [PMID: 38974988 PMCID: PMC11223994 DOI: 10.1210/jendso/bvae125] [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: 12/29/2023] [Indexed: 07/09/2024] Open
Abstract
Context The rise in continuous glucose monitor (CGM) use has been characterized by widening disparities between the least and most socially marginalized. Given access barriers, there is limited CGM patient experience information that is inclusive of those with type 2 diabetes mellitus from socially marginalized backgrounds. Objective To understand the CGM usage experience in the primary care setting across a US Medicaid population with type 2 diabetes at federally qualified health centers. Methods This qualitative study used semi-structured phone interviews with 28 English- or Spanish-speaking participants prescribed the CGM who were enrolled in a US Medicaid program that subsidized CGMs. Audio recordings of interviews were transcribed and analyzed by reflective thematic analysis. Results Twenty-eight participants (75% female, median age 56 years with interquartile-range 48-60 years) were interviewed. Participants were from different racial/ethnic backgrounds: 21% non-Hispanic White, 57% Hispanic, and 18% non-Hispanic Black. Participants primarily spoke English (68%) or Spanish (32%), and 53% reported 9 or fewer years of formal education. We identified 6 major themes: initial expectations and overcoming initiation barriers, convenience and ease promote daily use, increased knowledge leads to improved self-management, collaboration with provider and clinical team, improved self-reported outcomes, and barriers and burdens are generally tolerated. Conclusion CGM use was experienced as easy to understand and viewed as a tool for diabetes self-efficacy. Expanded CGM access for socially marginalized patients with type 2 diabetes can enhance diabetes self-management to help mitigate diabetes outcome disparities.
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Affiliation(s)
- Kevin Ni
- Medicine Service-Endocrinology, Denver Health, Denver, CO 80204, USA
- Department of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Carolyn A Tampe
- Medicine Service-Endocrinology, Denver Health, Denver, CO 80204, USA
| | - Kayce Sol
- Medicine Service-Endocrinology, Denver Health, Denver, CO 80204, USA
| | - Lilia Cervantes
- Department of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Rocio I Pereira
- Medicine Service-Endocrinology, Denver Health, Denver, CO 80204, USA
- Department of Medicine, University of Colorado, Aurora, CO 80045, USA
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9
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Nally LM, Sherr JL. Making diabetes technology accessible to all. Nat Med 2024; 30:1832-1833. [PMID: 38918631 DOI: 10.1038/s41591-024-03082-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Affiliation(s)
- Laura M Nally
- Yale University School of Medicine, New Haven, CT, USA
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10
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Evans EI, Pincus KJ, Seung H, Rochester-Eyeguokan CD. Health literacy of patients using continuous glucose monitoring. J Am Pharm Assoc (2003) 2024; 64:102109. [PMID: 38663532 DOI: 10.1016/j.japh.2024.102109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/30/2024] [Accepted: 04/18/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Low health literacy and numeracy are associated with poor health outcomes and lower self-efficacy. Continuous glucose monitors (CGMs) can improve diabetes management, but their benefits may be limited by health literacy levels. OBJECTIVES Our objective was to characterize health literacy levels of ambulatory care patients using CGMs to manage their diabetes in 1 urban health system. Secondary aims were to identify specific knowledge deficits related to CGM education and determine predictors of self-rated comfort with and understanding of CGM use. METHODS Participants with type 1 or type 2 diabetes using CGMs were identified using electronic medical records. Participants completed a telephone survey, including the Health Literacy Scale/Subjective Numeracy Scale (HLS/SNS) and an investigator-developed survey assessing CGM comfort and understanding. Descriptive statistics were reported for demographic information. The associations between patient characteristics and survey responses were evaluated using the chi-square test, Fisher's exact test, or Wilcoxon rank-sum test. RESULTS Eighty-two participants completed the surveys. The median HLS/SNS score for study participants was 80 (Interquartile range 71-89). Associations were found between HLS/SNS scores and education level, reported income, and private insurance coverage. Participants with higher HLS/SNS scores reported higher levels of CGM understanding and comfort. Fifty-one percent of participants (n = 42) reported no or inadequate training prior to CGM initiation. Better A1C results (<8%) were associated with higher self-rated responses in the investigator-developed survey. CONCLUSION CGMs should not be withheld from individuals with low health literacy. Incorporating baseline health literacy assessment and offering literacy sensitive training will help optimize the benefits derived from this technology.
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11
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Prahalad P, Scheinker D, Desai M, Ding VY, Bishop FK, Lee MY, Ferstad J, Zaharieva DP, Addala A, Johari R, Hood K, Maahs DM. Equitable implementation of a precision digital health program for glucose management in individuals with newly diagnosed type 1 diabetes. Nat Med 2024; 30:2067-2075. [PMID: 38702523 DOI: 10.1038/s41591-024-02975-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/03/2024] [Indexed: 05/06/2024]
Abstract
Few young people with type 1 diabetes (T1D) meet glucose targets. Continuous glucose monitoring improves glycemia, but access is not equitable. We prospectively assessed the impact of a systematic and equitable digital-health-team-based care program implementing tighter glucose targets (HbA1c < 7%), early technology use (continuous glucose monitoring starts <1 month after diagnosis) and remote patient monitoring on glycemia in young people with newly diagnosed T1D enrolled in the Teamwork, Targets, Technology, and Tight Control (4T Study 1). Primary outcome was HbA1c change from 4 to 12 months after diagnosis; the secondary outcome was achieving the HbA1c targets. The 4T Study 1 cohort (36.8% Hispanic and 35.3% publicly insured) had a mean HbA1c of 6.58%, 64% with HbA1c < 7% and mean time in the range (70-180 mg dl-1) of 68% at 1 year after diagnosis. Clinical implementation of the 4T Study 1 met the prespecified primary outcome and improved glycemia without unexpected serious adverse events. The strategies in the 4T Study 1 can be used to implement systematic and equitable care for individuals with T1D and translate to care for other chronic diseases. ClinicalTrials.gov registration: NCT04336969 .
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Affiliation(s)
- Priya Prahalad
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA.
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA.
| | - David Scheinker
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
- Clinical Excellence Research Center, Stanford University, Stanford, CA, USA
| | - Manisha Desai
- Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
| | - Victoria Y Ding
- Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
| | - Franziska K Bishop
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
| | - Ming Yeh Lee
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - Johannes Ferstad
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Dessi P Zaharieva
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - Ananta Addala
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
| | - Ramesh Johari
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Korey Hood
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
| | - David M Maahs
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
- Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA, USA
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12
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Thomson EA, Lee S, Xu H, Moeller H, Sands J, Lal RA, Annes JP, Poon ASY. Enhancing Therapeutic Insulin Transport from Macroencapsulated Islets Using Sub-Minute Pressure at Physiological Levels. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.12.11.570688. [PMID: 38168181 PMCID: PMC10760036 DOI: 10.1101/2023.12.11.570688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Cadaveric islet and stem cell-derived transplantations hold promise as treatments for type 1 diabetes. To tackle the issue of immunocompatibility, numerous cellular macroencapsulation techniques have been developed that utilize diffusion to transport insulin across an immunoisolating barrier. However, despite several devices progressing to human clinical trials, none have successfully managed to attain physiologic glucose control or insulin independence. Based on empirical evidence, macroencapsulation methods with multilayered, high islet surface density are incompatible with homeostatic, on-demand insulin delivery and physiologic glucose regulation, when reliant solely on diffusion. An additional driving force is essential to overcome the distance limit of diffusion. In this study, we present both theoretical proof and experimental validation that applying pressure at levels comparable to physiological diastolic blood pressure significantly enhances insulin flux across immunoisolation membranes-increasing it by nearly three orders of magnitude. This significant enhancement in transport rate allows for precise, sub-minute regulation of both bolus and basal insulin delivery. By incorporating this technique with a pump-based extravascular system, we demonstrate the ability to rapidly reduce glucose levels in diabetic rodent models, effectively replicating the timescale and therapeutic effect of subcutaneous insulin injection or infusion. This advance provides a potential path towards achieving insulin independence with islet macroencapsulation. One Sentence Summary Towards improved glucose control, applying sub-minute pressure at physiological levels enhances therapeutic insulin transport from macroencapsulated islets.
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13
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Auzanneau M, Kieninger DM, Laubner K, Renner C, Mirza J, Däublin G, Praedicow K, Haberland H, Steigleder-Schweiger C, Gohlke B, Galler A, Holl RW. Comparison of BMI and HbA1c changes before and during the COVID-19 pandemic in type 1 diabetes: a longitudinal population-based study. J Diabetes Metab Disord 2024; 23:573-583. [PMID: 38932874 PMCID: PMC11196535 DOI: 10.1007/s40200-023-01316-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/17/2023] [Indexed: 06/28/2024]
Abstract
Purpose To compare the changes in body weight and glycemic control before and during the COVID-19 pandemic in people with type 1 diabetes (T1D). Methods In 47,065 individuals with T1D from the German Diabetes Prospective Follow-up Registry (DPV), we compared the adjusted mean changes in BMI-Z-scores and HbA1c as well as the distribution of individual changes between four periods from March 2018 to February 2022, by sex and age group (4- < 11, 11- < 16, 16-50 years). Results At population level, the only significant pandemic effects were a slight increase in BMI Z-score in prepubertal children (girls: + 0.03 in the first COVID year vs. before, P < 0.01; boys: + 0.04, P < 0.01) as well as a stabilization of HbA1c in all subgroups or even improvement in women (- 0.08%, P < 0.01). At individual level, however, heterogeneity increased significantly (p < 0.01), especially in children. More prepubertal children gained weight (girls: 45% vs. 35% before COVID; boys: 39% vs. 33%). More pubertal girls lost weight (30% vs. 21%) and fewer gained weight (43% vs. 54%). More children had a decreasing HbA1c (prepubertal group: 29% vs. 22%; pubertal girls: 33% vs. 28%; pubertal boys: 32% vs. 25%) and fewer had increasing values. More women had stable HbA1c and fewer had increasing values (30% vs. 37%). In men, no significant changes were observed. Conclusion This real-world analysis shows no detrimental consequences of the two first COVID years on weight and HbA1c in T1D on average, but reveals, beyond the mean trends, a greater variability at the individual level.
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Affiliation(s)
- Marie Auzanneau
- Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Neuherberg Germany
| | - Dorothee M. Kieninger
- Diabetes Division, Department of Paediatrics, Universitätsmedizin Johannes Gutenberg Universität Mainz, Mainz, Germany
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Joaquina Mirza
- Kinderkrankenhaus Amsterdamer Straße, Paediatric Diabetology, Klinik Für Kinder- Und Jugendmedizin, Kliniken Köln, Cologne, Germany
| | | | - Kirsten Praedicow
- Clinic for Children and Adolescent Medicine, Diabetology and Endocrinology, Helios Clinical Centre Aue, Aue-Bad Schlema, Germany
| | - Holger Haberland
- Paediatric Diabetology, Klinik Für Kinder- Und Jugendmedizin, Sana Klinikum Lichtenberg, Berlin, Germany
| | | | - Bettina Gohlke
- Paediatric Endocrinology and Diabetology, University of Bonn, Bonn, Germany
| | - Angela Galler
- Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Und Humboldt-Universität Zu Berlin, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Neuherberg Germany
| | - on behalf of the DPV Initiative
- Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Neuherberg Germany
- Diabetes Division, Department of Paediatrics, Universitätsmedizin Johannes Gutenberg Universität Mainz, Mainz, Germany
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Pediatric Practice Deggendorf, Deggendorf, Germany
- Kinderkrankenhaus Amsterdamer Straße, Paediatric Diabetology, Klinik Für Kinder- Und Jugendmedizin, Kliniken Köln, Cologne, Germany
- Children’s Hospital Aurich, Aurich, Germany
- Clinic for Children and Adolescent Medicine, Diabetology and Endocrinology, Helios Clinical Centre Aue, Aue-Bad Schlema, Germany
- Paediatric Diabetology, Klinik Für Kinder- Und Jugendmedizin, Sana Klinikum Lichtenberg, Berlin, Germany
- Department of Paediatrics, Paracelsus Medical University, Salzburg, Austria
- Paediatric Endocrinology and Diabetology, University of Bonn, Bonn, Germany
- Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Und Humboldt-Universität Zu Berlin, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany
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Pemberton J, Collins L, Drummond L, Dias RP, Krone R, Kershaw M, Uday S. Enhancing equity in access to automated insulin delivery systems in an ethnically and socioeconomically diverse group of children with type 1 diabetes. BMJ Open Diabetes Res Care 2024; 12:e004045. [PMID: 38749509 PMCID: PMC11097826 DOI: 10.1136/bmjdrc-2024-004045] [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: 01/16/2024] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Manufacturer-supported didactic teaching programmes offer effective automated insulin delivery (AID) systems onboarding in children and young people (CYP) with type 1 diabetes (T1D). However, this approach has limited flexibility to accommodate the needs of families requiring additional support. RESEARCH DESIGN AND METHODS Evaluate the efficacy of an inperson manufacturer-supported didactic teaching programme (Group A), in comparison to a flexible flipped learning approach delivered virtually or inperson (Group B). Retrospective analysis of CYP with T1D using continuous glucose monitoring (CGM), who were initiated on AID systems between 2021 and 2023. Compare CGM metrics from baseline to 90 days for both groups A and B. Additionally, compare the two groups for change in CGM metrics over the 90-day period (∆), patient demographics and onboarding time. RESULTS Group A consisted of 74 CYP (53% male) with median age of 13.9 years and Group B 91 CYP (54% male) with median age of 12.7 years. From baseline to 90 days, Group A lowered mean (±SD) time above range (TAR, >10.0 mmol/L) from 47.6% (±15.0) to 33.2% (±15.0) (p<0.001), increased time in range (TIR, 3.9-10.0 mmol/L) from 50.4% (±14.0) to 64.7% (±10.2) (p<0.001). From baseline to 90 days, Group B lowered TAR from 51.3% (±15.1) to 34.5% (±11.3) (p<0.001) and increased TIR from 46.5% (±14.5) to 63.7% (±11.0) (p<0.001). There was no difference from baseline to 90 days for time below range (TBR, <3.9 mmol/L) for Group A and Group B. ∆ TAR, TIR and TBR for both groups were comparable. Group B consisted of CYP with higher socioeconomic deprivation, greater ethnic diversity and lower carer education achievement (p<0.05). The majority of Group B (n=79, 87%) chose virtual flipped learning, halving diabetes educator time and increasing onboarding cadence by fivefold. CONCLUSIONS A flexible virtual flipped learning programme increases onboarding cadence and capacity to offer equitable AID system onboarding.
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Affiliation(s)
- John Pemberton
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Louise Collins
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Lesley Drummond
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Renuka P Dias
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
| | - Ruth Krone
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Melanie Kershaw
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Suma Uday
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- University of Birmingham Institute of Metabolism and Systems Research, Birmingham, UK
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de Vries SAG, Bak JCG, Mul D, Wouters MWJM, Nieuwdorp M, Verheugt CL, Sas TCJ. Does size matter? Hospital volume and resource use in paediatric diabetes care. Diabet Med 2024; 41:e15260. [PMID: 38018287 DOI: 10.1111/dme.15260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023]
Abstract
AIMS Paediatric diabetes care has become increasingly specialised due to the multidisciplinary approach and technological developments. Guidelines recommend sufficient experience of treatment teams. This study evaluates associations between hospital volume and resource use and hospital expenditure in Dutch children with diabetes. METHODS Retrospective cohort study using hospital claims data of 5082 children treated across 44 Dutch hospitals (2019-2020). Hospitals were categorised into three categories; small (≥20-100 patients), medium (≥100-200 patients) and large (≥200 patients). All-cause hospitalisations, consultations, technology and hospital expenditure were analysed and adjusted for age, sex, socio-economic status (SES) and hospital of treatment. RESULTS Fewer hospitalisations were observed in large hospitals compared to small hospitals (OR 0.48; [95% CI 0.32-0.72]; p < 0.001). Median number of yearly paediatrician visits was 7 in large and 6 in small hospitals, the significance of which was attenuated in multilevel analysis (OR ≥7 consultations: 1.89; [95%CI 0.74-4.83]; p = 0.18). Technology use varies between individual hospitals, whereas pump usage and real-time continuous glucose monitoring showed no significant differences between hospital volumes. Mean overall expenditure was highest in medium-sized centres with €6434 per patient (IQR €2555-7955); the difference in diabetes care costs was not significant between hospital patient volumes. CONCLUSIONS Care provision patterns vary by hospital patient volume. Large hospitals had the lowest hospitalisation rates. The use of diabetes technology was not different between hospital patient volumes. Medium-sized hospitals showed the highest overall expenditure, but diabetes care costs were similar across hospital volumes.
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Affiliation(s)
- Silvia A G de Vries
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Jessica C G Bak
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Dick Mul
- Diabeter, Center for Pediatric and Adult Diabetes Care and Research, Rotterdam, The Netherlands
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, The Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Carianne L Verheugt
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Theo C J Sas
- Diabeter, Center for Pediatric and Adult Diabetes Care and Research, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Pediatric Endocrinology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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Nwosu BU, Pellizzari M, Pavlovic MN, Ciron J, Talib R, Sohail R. Virtual insulin pump initiation is safe effective in children adolescents with type 1 diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1362627. [PMID: 38745900 PMCID: PMC11091709 DOI: 10.3389/fcdhc.2024.1362627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024]
Abstract
Objective There is no head-to-head comparison of the safety and efficacy of virtual versus in-office insulin pump initiation for youth with type 1 diabetes in the US. The study's aim was to determine the safety and efficacy of virtual versus in-office pump initiation in pediatric type 1 diabetes. Research design and methods A longitudinal retrospective study of 112 subjects: 65% (n=73), ages 11.2 ± 3.8 years(y), received in-office training; and 35% (n=39), ages 12.0 ± 4.0y, received virtual training. The number of White subjects was 40 (55%) in the in-office group, and 25 (66%) in the remote group; while Black subjects were 11 (15%) in the in-office group and 4 (10%) in the virtual group. Data were collected at pump initiation, 3 and 6 months. Results There were no significant differences in sex, race, height, weight, BMI, and the duration of diabetes between the groups at baseline. There was no significant difference in A1c between the groups at 0, 3, and 6 months. A1c correlated significantly with the glucose management indicator at 0, 3, and 6 months: baseline: r=0.49, p<0.0001; 3 months: r=0.77, p<0.0001; and 6 months: r=0.71, p<0.0001. There was no relationship between A1c or TIR and pubertal status, BMI, sex, or race. A1c was significantly elevated in the non-White individuals at 6 months only: 57.9 mmol/mol (50.8-69.4) versus 51.9 mmol/mol (46.5-59.6)], p=0.007. Conclusion Virtual insulin pump initiation is safe and effective in children with type 1 diabetes. This approach could accelerate the adoption of the use of diabetes technology in minority populations in the US.
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Affiliation(s)
- Benjamin Udoka Nwosu
- Division of Endocrinology, Department of Pediatrics, Cohen Children’s Medical Center, Hempstead, NY, United States
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Queens, NY, United States
| | - Margaret Pellizzari
- Division of Endocrinology, Department of Pediatrics, Cohen Children’s Medical Center, Hempstead, NY, United States
| | - Maia N. Pavlovic
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Queens, NY, United States
| | - Jason Ciron
- Division of Endocrinology, Department of Pediatrics, Cohen Children’s Medical Center, Hempstead, NY, United States
| | - Rashida Talib
- Division of Endocrinology, Department of Pediatrics, Cohen Children’s Medical Center, Hempstead, NY, United States
| | - Rubab Sohail
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, NY, United States
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17
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Sandy JL, Tittel SR, Rompicherla S, Karges B, James S, Rioles N, Zimmerman AG, Fröhlich-Reiterer E, Maahs DM, Lanzinger S, Craig ME, Ebekozien O. Demographic, Clinical, Management, and Outcome Characteristics of 8,004 Young Children With Type 1 Diabetes. Diabetes Care 2024; 47:660-667. [PMID: 38305782 DOI: 10.2337/dc23-1317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/08/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To compare demographic, clinical, and therapeutic characteristics of children with type 1 diabetes age <6 years across three international registries: Diabetes Prospective Follow-Up Registry (DPV; Europe), T1D Exchange Quality Improvement Network (T1DX-QI; U.S.), and Australasian Diabetes Data Network (ADDN; Australasia). RESEARCH DESIGN AND METHODS An analysis was conducted comparing 2019-2021 prospective registry data from 8,004 children. RESULTS Mean ± SD ages at diabetes diagnosis were 3.2 ± 1.4 (DPV and ADDN) and 3.7 ± 1.8 years (T1DX-QI). Mean ± SD diabetes durations were 1.4 ± 1.3 (DPV), 1.4 ± 1.6 (T1DX-QI), and 1.5 ± 1.3 years (ADDN). BMI z scores were in the overweight range in 36.2% (DPV), 41.8% (T1DX-QI), and 50.0% (ADDN) of participants. Mean ± SD HbA1c varied among registries: DPV 7.3 ± 0.9% (56 ± 10 mmol/mol), T1DX-QI 8.0 ± 1.4% (64 ± 16 mmol/mol), and ADDN 7.7 ± 1.2% (61 ± 13 mmol/mol). Overall, 37.5% of children achieved the target HbA1c of <7.0% (53 mmol/mol): 43.6% in DPV, 25.5% in T1DX-QI, and 27.5% in ADDN. Use of diabetes technologies such as insulin pump (DPV 86.6%, T1DX 46.6%, and ADDN 39.2%) and continuous glucose monitoring (CGM; DPV 85.1%, T1DX-QI 57.6%, and ADDN 70.5%) varied among registries. Use of hybrid closed-loop (HCL) systems was uncommon (from 0.5% [ADDN] to 6.9% [DPV]). CONCLUSIONS Across three major registries, more than half of children age <6 years did not achieve the target HbA1c of <7.0% (53 mmol/mol). CGM was used by most participants, whereas insulin pump use varied across registries, and HCL system use was rare. The differences seen in glycemia and use of diabetes technologies among registries require further investigation to determine potential contributing factors and areas to target to improve the care of this vulnerable group.
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Affiliation(s)
- Jessica L Sandy
- Sydney Children's Hospital Network, Westmead, New South Wales, Australia
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Sascha R Tittel
- Institute for Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, Ulm University, Ulm, Germany
- German Centre for Diabetes Research, Munich-Neuherberg, Germany
| | | | - Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, Rheinisch-Westfälische Technische Hochschule, Aachen University, Aachen, Germany
| | - Steven James
- University of the Sunshine Coast, Petrie, Queensland, Australia
| | | | | | - Elke Fröhlich-Reiterer
- Division of General Paediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA
| | - Stefanie Lanzinger
- Institute for Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, Ulm University, Ulm, Germany
- German Centre for Diabetes Research, Munich-Neuherberg, Germany
| | - Maria E Craig
- Sydney Children's Hospital Network, Westmead, New South Wales, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales Medicine Sydney, Sydney, New South Wales, Australia
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Charles Perkins Centre, Westmead, New South Wales, Australia
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18
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Lomax KE, Taplin CE, Abraham MB, Smith GJ, Haynes A, Zomer E, Ellis KL, Clapin H, Zoungas S, Jenkins AJ, Harrington J, de Bock MI, Jones TW, Davis EA. Improved Glycemic Outcomes With Diabetes Technology Use Independent of Socioeconomic Status in Youth With Type 1 Diabetes. Diabetes Care 2024; 47:707-711. [PMID: 38324670 DOI: 10.2337/dc23-2033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/10/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Technology use in type 1 diabetes (T1D) is impacted by socioeconomic status (SES). This analysis explored relationships between SES, glycemic outcomes, and technology use. RESEARCH DESIGN AND METHODS A cross-sectional analysis of HbA1c data from 2,822 Australian youth with T1D was undertaken. Residential postcodes were used to assign SES based on the Index of Relative Socio-Economic Disadvantage (IRSD). Linear regression models were used to evaluate associations among IRSD quintile, HbA1c, and management regimen. RESULTS Insulin pump therapy, continuous glucose monitoring, and their concurrent use were associated with lower mean HbA1c across all IRSD quintiles (P < 0.001). There was no interaction between technology use and IRSD quintile on HbA1c (P = 0.624), reflecting a similar association of lower HbA1c with technology use across all IRSD quintiles. CONCLUSIONS Technology use was associated with lower HbA1c across all socioeconomic backgrounds. Socioeconomic disadvantage does not preclude glycemic benefits of diabetes technologies, highlighting the need to remove barriers to technology access.
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Affiliation(s)
- Kate E Lomax
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Craig E Taplin
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Mary B Abraham
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Division of Paediatrics Within the Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Grant J Smith
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Aveni Haynes
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Katrina L Ellis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Helen Clapin
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alicia J Jenkins
- Diabetes and Vascular Medicine, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer Harrington
- Division of Endocrinology, Women's and Children's Health Network, North Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Martin I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Division of Paediatrics Within the Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Division of Paediatrics Within the Medical School, The University of Western Australia, Perth, Western Australia, Australia
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Wardell J, Albright D, Chang C, Plegue MA, Lee JE, Hirschfeld E, Garrity A, Lee JM, DeJonckheere M. Association Between Psychosocial Acuity and Glycemic Control in a Pediatric Type 1 Diabetes Clinic. Sci Diabetes Self Manag Care 2024; 50:116-129. [PMID: 38456252 PMCID: PMC11042759 DOI: 10.1177/26350106241232634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
PURPOSE The purpose of this study was to describe the frequency of psychosocial risk and its associations with glycemic levels in youth with type 1 diabetes (T1D) seen by social work staff during regular clinical care. METHODS A retrospective longitudinal analysis of observational clinical data was conducted. Individuals (1-26 years) with known T1D who were seen at a pediatric diabetes clinic in a US academic medical center between 2014 and 2021 were included. Variables included psychosocial acuity, A1C, and demographic characteristics. Chi-square tests, Wilcoxon rank sum tests, and mixed linear regressions were used to examine associations between demographic variables, psychosocial acuity, and A1C. RESULTS Of 966 patients, 513 (53.1%) were male, 76 (7.9%) were non-Hispanic Black, and 804 (83.2%) were non-Hispanic White. There was a mean of 6.9 annual social work encounters per patient, with 3 psychosocial domains measured at each visit. Results showed that as psychosocial acuity level increased, glycemic control decreased. There were significant differences in A1C according to race/ethnicity, insurance, age, and psychosocial acuity. CONCLUSIONS In a real-world clinical population, psychosocial acuity was associated with glycemic control. Presenting for psychosocial issues in their diabetes clinic was associated with reduced glycemic control among youth with T1D. There is an opportunity to connect pediatric patients with appropriate mental health services and psychosocial supports.
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Affiliation(s)
- Joseph Wardell
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Dana Albright
- Parkview Mirro Center for Research and Innovation, Fort Wayne, Indiana
| | - Claire Chang
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Melissa A Plegue
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Jung Eun Lee
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Emily Hirschfeld
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Ashley Garrity
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Joyce M Lee
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
- Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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Burckhardt MA, Addala A, de Bock M. Editorial: Equity in type 1 diabetes technology and beyond: where are we in 2022? Front Endocrinol (Lausanne) 2024; 15:1400240. [PMID: 38596223 PMCID: PMC11002255 DOI: 10.3389/fendo.2024.1400240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024] Open
Affiliation(s)
- Marie-Anne Burckhardt
- Pediatric Endocrinology and Diabetology, University Children’s Hospital, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Ananta Addala
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, United States
| | - Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
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21
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Been RA, Lameijer A, Gans ROB, van Beek AP, Kingsnorth AP, Choudhary P, van Dijk PR. The impact of socioeconomic factors, social determinants, and ethnicity on the utilization of glucose sensor technology among persons with diabetes mellitus: a narrative review. Ther Adv Endocrinol Metab 2024; 15:20420188241236289. [PMID: 38476216 PMCID: PMC10929059 DOI: 10.1177/20420188241236289] [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: 06/19/2023] [Accepted: 02/08/2024] [Indexed: 03/14/2024] Open
Abstract
Continuous glucose monitoring (CGM) usage has been shown to improve disease outcomes in people living with diabetes by facilitating better glycemic management. However, previous research has suggested that access to these devices can be influenced by nonmedical factors such as socioeconomic status and ethnicity. It is critical that equitable access to CGM devices is ensured as people from those groups experience poorer diabetes-related health outcomes. In this narrative review, we provide an overview of the various healthcare systems worldwide and how socioeconomic status, social context, and ethnicity shape device usage and the associated health outcomes. In general, we found that having a lower socioeconomic status and belonging to an ethnic minority group negatively impact CGM usage. While financial means proved to be an important mediator in this process, it was not the sole driver as disparities persisted even after adjustment for factors such as income and insurance status. Recommendations to increase CGM usage for people of a lower socioeconomic status and ethnic minorities include increasing the availability of financial, administrative, and educational support, for both patients and healthcare providers. However, recommendations will vary due to local country-specific circumstances, such as reimbursement criteria and healthcare ecosystems.
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Affiliation(s)
- Riemer A. Been
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Annel Lameijer
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Reinold O. B. Gans
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - André P. van Beek
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Andrew P. Kingsnorth
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Pratik Choudhary
- University of Leicester, Leicester General Hospital, Leicester, Leicester Diabetes Centre – Bloom, UK
| | - Peter R. van Dijk
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
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22
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Wu V, Choleva L, Wilkes M. Optimizing Glycemic Outcomes for Children with Type 1 Diabetes. Endocrinol Metab Clin North Am 2024; 53:27-38. [PMID: 38272596 DOI: 10.1016/j.ecl.2023.09.002] [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: 01/27/2024]
Abstract
Changes in physical growth, neurocognitive development, and pubertal maturation are some of the challenges to achieving blood glucose targets in children with type 1 diabetes mellitus. To optimize glycemic outcomes, a comprehensive approach is crucial to address psychosocial needs, expand the use of diabetes technology, and diminish health inequities.
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Affiliation(s)
- Vickie Wu
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box #1616, Annenberg Building, 4th Floor, New York, NY 10029, USA
| | - Lauryn Choleva
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box #1616, Annenberg Building, 4th Floor, New York, NY 10029, USA
| | - Meredith Wilkes
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box #1616, Annenberg Building, 4th Floor, New York, NY 10029, USA.
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23
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Dovc K, Bode BW, Battelino T. Continuous and Intermittent Glucose Monitoring in 2023. Diabetes Technol Ther 2024; 26:S14-S31. [PMID: 38441451 DOI: 10.1089/dia.2024.2502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Klemen Dovc
- University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bruce W Bode
- Atlanta Diabetes Associates and Emory University School of Medicine, Atlanta, GA, USA
| | - Tadej Battelino
- University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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24
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Addala A, Weinzimer SA. Diabetes Technology in the "Real World": Expanding Access and Addressing Disparities. Diabetes Technol Ther 2024; 26:S187-S200. [PMID: 38441450 DOI: 10.1089/dia.2024.2512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Ananta Addala
- Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Stanford University, Palo Alto, CA
| | - Stuart A Weinzimer
- Department of Pediatrics, School of Medicine, Yale University, New Haven, CT
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Abstract
Recent years witnessed advancements in diabetes technologies and therapeutics. People with type 1 diabetes have more options to control their blood glucose, prevent hypoglycemia, and spend more time with their loved ones. Newer diabetes technologies and therapeutics improve the quality of life and boost the confidence of people with type 1 diabetes. In parallel to changes in the diabetes technology field, stem cell research has been evolving. Gene editing and production of β cells from stem cells are ongoing. The current focus of cure studies is how to increase the survival of cells produced with stem cells. New adjunctive therapies are under development.
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Affiliation(s)
- Halis Kaan Akturk
- Barbara Davis Center for Diabetes, University of Colorado, 1775 Aurora Court, Room 1319, Aurora, CO 80045, USA.
| | - Alexis M McKee
- Division of Endocrinology, Metabolism & Lipid Research, Washington University in St. Louis School of Medicine, St Louis, MO, USA
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26
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Maahs DM, Prahalad P, Schweiger DS, Shalitin S. Diabetes Technology and Therapy in the Pediatric Age Group. Diabetes Technol Ther 2024; 26:S117-S140. [PMID: 38441448 DOI: 10.1089/dia.2024.2508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
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
| | - Priya Prahalad
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
| | - Darja Smigoc Schweiger
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - 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
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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27
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Grammes J, Schmid S, Bozkurt L, Heinemann L, Hess G, Kubiak T, Küstner E, Priesterroth LS, Stahl C, Holl RW. Continuous glucose monitoring in older adults with diabetes: Data from the diabetes prospective follow-up (DPV) registry. Diabet Med 2024; 41:e15261. [PMID: 38009855 DOI: 10.1111/dme.15261] [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: 09/13/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
AIMS To analyse predictors for continuous glucose monitoring (CGM) use in people with diabetes aged ≥60 years using insulin therapy and to assess the rates of CGM use during recent years (2019-2021). RESEARCH DESIGN AND METHODS Prospective study including 6849 individuals with diabetes and insulin therapy (type 2 diabetes: n = 5320; type 1 diabetes: n = 1529) aged ≥60 years. Data from 129 treatment centres were retrieved from the Diabetes Prospective Follow-up Registry (DPV) in March 2023. RESULTS Sensor use in individuals aged ≥60 years has increased in type 1 (2019: 28%, 2020: 39%, 2021: 45%) and type 2 diabetes (2019: 10%, 2020: 16%, 2021: 18%). Predictors for sensor use in older individuals with type 1 diabetes are younger age and CSII use (p < 0.001). Predictors in older individuals with type 2 diabetes are younger age, longer diabetes duration, higher BMI and CSII use (p < 0.001). CONCLUSIONS CGM has become more common in older adults with diabetes and will presumably increase further. Age is a predictor for sensor use in older adults with diabetes. Age-related physical barriers and insufficient usability of devices, lack of interest in technologies, but possibly also effects of prejudice on the grounds of age may contribute to this finding.
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Affiliation(s)
- Jennifer Grammes
- Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Stefanie Schmid
- Institute of Epidemiology and Medical Biometry, CAQM, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
| | - Latife Bozkurt
- Department of Internal Medicine III and Karl Landsteiner Institute for Metabolic Disorders and Nephrology, Clinic Hietzing, Vienna Health Care Group, Vienna, Austria
| | | | - Gregor Hess
- Diabetology Private Practice, Worms, Germany
| | - Thomas Kubiak
- Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | | | | | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, CAQM, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
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28
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Lingen K, Maahs D, Bellini N, Isaacs D. Removing Barriers, Bridging the Gap, and the Changing Role of the Health Care Professional with Automated Insulin Delivery Systems. Diabetes Technol Ther 2024; 26:45-52. [PMID: 38377318 DOI: 10.1089/dia.2023.0440] [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: 02/22/2024]
Abstract
As all people with type 1 diabetes (T1D) and some with type 2 diabetes (T2D) require insulin, there is a need to develop management methods that not only achieve glycemic targets but also reduce the burden of living with diabetes. After insulin pumps and continuous glucose monitors, the next step in the evolution of diabetes technology is automated insulin delivery (AID) systems, which have transformed intensive insulin management over the past decade, as these systems address the shortcomings of previous management options. However, AID use remains fairly limited, and access represents a major barrier to use for many people with diabetes, despite these systems being standard of care. Therefore, the future of AID will necessitate addressing barriers related to social determinants of health, finances, and an expansion of the number and type of health care professionals (HCPs) prescribing AID systems. These crucial steps will be essential to ensure that everyone with intensively managed diabetes can use AID systems. The impact of implementing these changes will create a shift in the future of diabetes care that will result in achievement of more targeted glycemia and psychosocial outcomes for all people with diabetes and an expansion of the role of all HCPs in AID-related diabetes care. Even more importantly, by addressing social determinants of health and clinical inertia related to AID, the field can address disparities in outcomes across countries, race, gender, socioeconomic status, and insurance status. Furthermore, the increased use of AID system will provide more time during appointments for a shift in the discussion away from fine tuning insulin dosing and toward a focus on more topics related to behavior and conversations about general health. This will include psychosocial outcomes, and quality of life. In addition, these changes can hopefully allow for time to discuss more general issues, such as cardiovascular health, obesity prevention, diabetes-related complications, and other health-related concerns.
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Affiliation(s)
| | - David Maahs
- Division of Pediatric Endocrinology, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, California, USA
| | - Natalie Bellini
- Department of Endocrinology, University Hospitals Cleveland, Cleveland, Ohio, USA
| | - Diana Isaacs
- Endocrinology and Metabolism Institute, Cleveland Clinic, Ohio, USA
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29
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Addala A, Medina Penaranda R, Naranjo D, Maahs DM, Hood KK. Intersectional identities play a role in perceived discrimination for families living with type 1 diabetes. Diabetes Res Clin Pract 2024; 209:111568. [PMID: 38364908 DOI: 10.1016/j.diabres.2024.111568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Ananta Addala
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States; Stanford Diabetes Research Center, Stanford University, Stanford, CA, United States.
| | - Ricardo Medina Penaranda
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
| | - Diana Naranjo
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States; Stanford Diabetes Research Center, Stanford University, Stanford, CA, United States
| | - David M Maahs
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States; Stanford Diabetes Research Center, Stanford University, Stanford, CA, United States
| | - Korey K Hood
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States; Stanford Diabetes Research Center, Stanford University, Stanford, CA, United States
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30
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Marks BE, Grundman JB, Meighan S, Monaghan M, Streisand R, Perkins A. Hybrid Closed Loop Systems Improve Glycemic Control and Quality of Life in Historically Minoritized Youth with Diabetes. Diabetes Technol Ther 2024; 26:167-175. [PMID: 38444316 PMCID: PMC11071108 DOI: 10.1089/dia.2023.0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Background: We assessed changes in glycemic control and person-reported outcome measures (PROMs) with t:slim X2 insulin pump with Control-IQ technology use among historically minoritized youth who are least likely to access hybrid closed loop (HCL) technology. Methods: This single-arm, prospective pilot study enrolled 15 publicly insured, insulin pump-naïve, non-Hispanic Black youth ages 6 to <21 years with type 1 diabetes and hemoglobin A1c (HbA1c) ≥10% in a 6-month study of HCL use. The primary outcome was absolute change in time in range (TIR) (70-180 mg/dL). Secondary outcomes included other continuous glucose monitor metrics, PROMs, and diabetic ketoacidosis (DKA) incidence. Results: For 13 youth (median 14.8 years, 53.3% female, HbA1c 11.7%) who completed the study, baseline TIR of 12.3% (6.3-27.1%) increased 23.7%-points (16.9, 30.5%; P < 0.001) or 5.7 h per day. Percent time >250 mg/dL decreased 33.9%-points (-44.8, -23.1%; P < 0.001) or 8.1 h per day from a baseline of 69.4% (51.6, 84.0%). Median time in HCL was 78.3% (59.7, 87.3%). Youth received 10.1 (9.2, 11.9) boluses per day, 71.7% (63.8, 79.3%) of which were HCL-initiated autoboluses. Diabetes-specific quality of life increased among parents (P < 0.001) and youth (P = 0.004), and diabetes distress decreased in both groups (P < 0.001, P = 0.005). Improvements in glycemia did not correlate with any baseline youth or parent PROMs. DKA was high at baseline (67 episodes/100-person years) and did not increase during the intervention (72 episodes/100-person years, P = 0.78). Conclusion: Improvements in glycemic control and quality of life exceeding pivotal trial findings without increased safety risks among historically minoritized youth emphasize the need for equitable access to HCL systems. ClinicalTrials.gov: clinicaltrials.gov ID (NCT04807374).
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Affiliation(s)
- Brynn E. Marks
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jody B. Grundman
- Division of Endocrinology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Seema Meighan
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Maureen Monaghan
- Division of Endocrinology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Randi Streisand
- Division of Endocrinology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Amanda Perkins
- Division of Endocrinology, Children's National Medical Center, Washington, District of Columbia, USA
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31
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Mitchell LM, Huang ES. Diffusion and Disparities: Rural Uptake of Continuous Glucose Monitors. Diabetes Care 2024; 47:344-345. [PMID: 38394638 PMCID: PMC10909676 DOI: 10.2337/dci23-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Affiliation(s)
- Lauren M. Mitchell
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | - Elbert S. Huang
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL
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Schütz A, Rami-Merhar B, Schütz-Fuhrmann I, Blauensteiner N, Baumann P, Pöttler T, Mader JK. Retrospective Comparison of Commercially Available Automated Insulin Delivery With Open-Source Automated Insulin Delivery Systems in Type 1 Diabetes. J Diabetes Sci Technol 2024:19322968241230106. [PMID: 38366626 DOI: 10.1177/19322968241230106] [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: 02/18/2024]
Abstract
BACKGROUND Automated insulin delivery (AID) systems have shown to improve glycemic control in a range of populations and settings. At the start of this study, only one commercial AID system had entered the Austrian market (MiniMed 670G, Medtronic). However, there is an ever-growing community of people living with type 1 diabetes (PWT1D) using open-source (OS) AID systems. MATERIALS AND METHODS A total of 144 PWT1D who used either the MiniMed 670G (670G) or OS-AID systems routinely for a period of at least three to a maximum of six months, between February 18, 2020 and January 15, 2023, were retrospectively analyzed (116 670G aged from 2.6 to 71.8 years and 28 OS-AID aged from 3.4 to 53.5 years). The goal is to evaluate and compare the quality of glycemic control of commercially available AID and OS-AID systems and to present all data by an in-depth descriptive analysis of the population. No statistical tests were performed. RESULTS The PWT1D using OS-AID systems spent more time in range (TIR)70-180 mg/dL (81.7% vs 73.9%), less time above range (TAR)181-250 mg/dL (11.1% vs 19.6%), less TAR>250 mg/dL (2.5% vs 4.3%), and more time below range (TBR)54-69 mg/dL (2.2% vs 1.7%) than PWT1D using the 670G system. The TBR<54 mg/dL was comparable in both groups (0.3% vs 0.4%). In the OS-AID group, median glucose level and glycated hemoglobin (HbA1c) were lower than in the 670G system group (130 vs 150 mg/dL; 6.2% vs 7.0%). CONCLUSION In conclusion, both groups were able to achieve satisfactory glycemic outcomes independent of age, gender, and diabetes duration. However, the PWT1D using OS-AID systems attained an even better glycemic control with no clinical safety concerns.
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Affiliation(s)
- Anna Schütz
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ingrid Schütz-Fuhrmann
- Karl Landsteiner Institute, Endocrinology and Nephrology, Vienna, Austria
- Department of Endocrinology and Nephrology, Clinic Hietzing, Vienna Health Care Group, Vienna, Austria
| | - Nicole Blauensteiner
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Petra Baumann
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tina Pöttler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Stocco A, Trawley S, Kong YW, Yuan CY, Kiburg K, Pham C, Brown K, Partovi A, Roem K, Harrison N, Fourlanos S, Ekinci EI, O'Neal DN. "You can hide it if you want to, you can let it be seen if you want to": A qualitative study of the lived experiences of Australian adults with type 1 diabetes using the Omnipod DASH® system. Diabetes Res Clin Pract 2024; 208:111123. [PMID: 38309532 DOI: 10.1016/j.diabres.2024.111123] [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: 10/27/2023] [Revised: 01/10/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
AIMS Understanding the lived experience of using a tubeless insulin pump and how this differs compared to usual care (tubed insulin pump therapy (IPT) vs multiple daily injections (MDI)). METHODS Interviews were conducted after 12-weeks of using the Omnipod DASH Insulin Management System (Insulet, Acton, MA) and analysed using thematic analysis. RESULTS Fifty-eight adults (35 female; mean age 42;SD 13 years; 35 previous MDI) were interviewed. Most (84 %) wanted to continue using the device. Experiences fit two themes: 1. Taking back control of my diabetes: many previous MDI users perceived improved glycaemic control, explained by more "nuanced" control, with some reporting positive effects during exercise and sleep. Many previous MDI and IPT users endorsed positive experiences in concealing or disclosing their diabetes to others. However, some previous MDI users reported negative psychosocial experiences due to feeling continuously "attached" to their diabetes. 2. Barriers and facilitators of device acceptability: both MDI and IPT users cited wearability, alarms and the financial cost impacted their choice to continue device use. IPT users reported positive wearability experiences. CONCLUSIONS The tubeless pump improved diabetes management perceptions for both MDI and tubed pump users. However, participants' prior glucose management affected perceptions of its advantages and disadvantages.
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Affiliation(s)
- Amber Stocco
- Cairnmillar Institute, Camberwell, Victoria, Australia
| | - Steven Trawley
- Cairnmillar Institute, Camberwell, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Yee Wen Kong
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, Victoria, Australia; Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Cheng Yi Yuan
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, Victoria, Australia; Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Katerina Kiburg
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, Victoria, Australia; Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Cecilia Pham
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia; The Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia
| | - Katrin Brown
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, Victoria, Australia; Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | | | - Kerryn Roem
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Harrison
- Geelong Endocrinology and Diabetes, Geelong, Victoria, Australia
| | - Spiros Fourlanos
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; The Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia
| | - Elif I Ekinci
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia; The Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia
| | - David N O'Neal
- Diabetes Technology Research Group, The University of Melbourne, Melbourne, Victoria, Australia; Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; The Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia
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Weisman A, Brown R, Chu L, Aronson R, Perkins BA. Factors Associated With Attainment of Glycemic Targets Among Adults With Type 1 and Type 2 Diabetes in Canada: A Cross-sectional Study Using Primary and Specialty Care Electronic Medical Record Data. Can J Diabetes 2024; 48:44-52.e5. [PMID: 37717631 DOI: 10.1016/j.jcjd.2023.09.001] [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: 06/02/2023] [Revised: 08/04/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE Using a new database combining primary and specialty care electronic medical record (EMR) data in Canada, we determined attainment of glycemic targets and associated predictors among adults with diabetes. METHODS We conducted a cross-sectional observational study combining primary and specialty care EMR data in Canada. Adults with diabetes whose primary care provider contributed to the National Diabetes Repository or who were assessed at a diabetes specialty clinic (LMC Diabetes and Endocrinology) between July 3, 2015, and June 30, 2019, were included. Diabetes type was categorized as type 2 diabetes (T2D) not prescribed insulin, T2D prescribed insulin, and type 1 diabetes (T1D). Covariates were age, sex, income quintile, province, rural/urban location, estimated glomerular filtration rate, medications, and insulin pump use. Associations between predictors and the outcome (glycated hemoglobin [A1C] of ≤7.0%) were assessed by multivariable logistic regressions. RESULTS Among 122,106 adults, consisting of 91,366 with T2D not prescribed insulin, 25,131 with T2D prescribed insulin, and 5,609 with T1D, attainment of an A1C of ≤7.0% was 60%, 25%, and 23%, respectively. Proportions with an A1C of ≤7.5% and ≤8.0% were 75% and 84% for those with T2D not prescribed insulin, 41% and 57% for those with T2D prescribed insulin, and 37% and 53% for those with T1D. Highest vs lowest income quintile was associated with greater odds of meeting the A1C target (adjusted odds ratio [95% confidence interval] for each diabetes category: 1.15 [1.10 to 1.21], 1.21 [1.10 to 1.33], and 1.29 [1.04 to 1.60], respectively). Individuals in Alberta and Manitoba had less antihyperglycemic medication use and attainment of A1C target than other provinces. CONCLUSIONS Attainment of glycemic targets among adults with diabetes was poor and differed by income and geographic location, which must be addressed in national diabetes strategies.
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Affiliation(s)
- Alanna Weisman
- ICES, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.
| | - Ruth Brown
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
| | - Lisa Chu
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
| | | | - Bruce A Perkins
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
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Subramanian S, Khan F, Hirsch IB. New advances in type 1 diabetes. BMJ 2024; 384:e075681. [PMID: 38278529 DOI: 10.1136/bmj-2023-075681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Type 1 diabetes is an autoimmune condition resulting in insulin deficiency and eventual loss of pancreatic β cell function requiring lifelong insulin therapy. Since the discovery of insulin more than 100 years ago, vast advances in treatments have improved care for many people with type 1 diabetes. Ongoing research on the genetics and immunology of type 1 diabetes and on interventions to modify disease course and preserve β cell function have expanded our broad understanding of this condition. Biomarkers of type 1 diabetes are detectable months to years before development of overt disease, and three stages of diabetes are now recognized. The advent of continuous glucose monitoring and the newer automated insulin delivery systems have changed the landscape of type 1 diabetes management and are associated with improved glycated hemoglobin and decreased hypoglycemia. Adjunctive therapies such as sodium glucose cotransporter-1 inhibitors and glucagon-like peptide 1 receptor agonists may find use in management in the future. Despite these rapid advances in the field, people living in under-resourced parts of the world struggle to obtain necessities such as insulin, syringes, and blood glucose monitoring essential for managing this condition. This review covers recent developments in diagnosis and treatment and future directions in the broad field of type 1 diabetes.
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Affiliation(s)
- Savitha Subramanian
- University of Washington Diabetes Institute, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
| | - Farah Khan
- University of Washington Diabetes Institute, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
| | - Irl B Hirsch
- University of Washington Diabetes Institute, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
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Baboun D, Solano N, Del Toro V, Alvarez-Salvat R, Granados A, Carrillo-Iregui A. Technology use and clinical outcomes in a racial-ethnic minority cohort of children and adolescents with type 1 diabetes. J Pediatr Endocrinol Metab 2023; 36:1128-1132. [PMID: 37852007 DOI: 10.1515/jpem-2023-0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES Technology use has been shown to improve diabetes control, but minority youths tend to have low rates of technology use and exhibit suboptimal glycemic control. We examined the impact of continuous glucose monitors (CGM) and continuous subcutaneous insulin infusion (CSII) on glycemic control in a racial-ethnic minority cohort of children and adolescents with type 1 diabetes (T1D). METHODS A cross-sectional study was conducted among 140 pediatric T1D patients seen at a multidisciplinary clinic. From January to November 2022, data on demographics and glycated hemoglobin (HbA1c) levels were collected. Patients were categorized as technology (CGM, CSII, or both) or non-technology users (finger stick meter (FS) and multiple daily injections (MDI)). RESULTS The majority identified as Hispanic (79 %) and had public health insurance (71 %). Sixty-nine percent used technology. Compared with non-technology users, technology users had significantly lower mean HbA1c levels (9.60 vs. 8.40 %, respectively) (p=0.0024), though no group (CGM + CSII, CGM + MDI, FS + CSII, and FS + MDI) achieved a mean HbA1c level of <7.0 %. Regarding minority status, no significant differences in mean HbA1c levels existed between Hispanics and Blacks in the CGM + MDI and FS + CSII groups (p=0.2232 and p=0.9224, respectively). However, there was a significant difference in mean HbA1c levels between Hispanic and Black non-technology users (9.19 vs. 11.26 %, respectively) (p=0.0385). CONCLUSIONS Technology users demonstrated better glycemic control than non-technology users. Further research is needed to investigate factors affecting glycemic control in minority youths with T1D.
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Affiliation(s)
- Daniela Baboun
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Natalia Solano
- University of Chicago, Chicago, USA
- Department of Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Victoria Del Toro
- Department of Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
- Vanderbilt University, Nashville, USA
| | | | - Andrea Granados
- Department of Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Adriana Carrillo-Iregui
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
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Nir J, Liberman A, Yackobovitch-Gavan M, Fraser D, Phillip M, Oron T. Nondisclosure of Type 1 Diabetes in Adolescence: A Single-Center Experience. Diabetes Spectr 2023; 37:124-129. [PMID: 38756425 PMCID: PMC11093764 DOI: 10.2337/ds23-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Objective The aim of this study was to assess the extent of nondisclosure of type 1 diabetes in adolescents and investigate its association with several psychosocial parameters and clinical outcomes. Research design and methods This was a cross-sectional study based on data collected from 69 adolescents with type 1 diabetes who were 12-18 years of age and followed at our diabetes clinic. The degree of disclosure, demographics, diabetes management, and psychosocial issues were assessed via questionnaires. Clinical parameters were derived from medical records. Associations between nondisclosure status and clinical and psychosocial study variables were assessed. Results Fifty-three participants (77%) reported some extent of nondisclosure. Nondisclosure was associated with low self-esteem, reduced friend support, and increased diabetes-related worries. Nondisclosure was also found to be associated with diminished self-care behaviors related to insulin administration and with elevated A1C. Conclusion Our results demonstrate that nondisclosure of type 1 diabetes in adolescents may be more common than initially recognized and is likely associated with unfavorable psychological outcomes and reduced self-care and diabetes management. Our results emphasize the importance of social interactions and disclosure in adolescents and may serve as a potential stepping stone to address other social barriers hindering diabetes management.
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Affiliation(s)
- Judith Nir
- The 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
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Liberman
- The 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
| | - Michal Yackobovitch-Gavan
- The 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
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Drora Fraser
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheeba, Israel
| | - Moshe Phillip
- The 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
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Oron
- The 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
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Addala A. Making a Good Thing Even Better: Expanding Access and Applicability of Automated Insulin Delivery Systems to Benefit All Youth With Type 1 Diabetes. Diabetes Care 2023; 46:2126-2128. [PMID: 38011525 DOI: 10.2337/dci23-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Ananta Addala
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA
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Hughes MS, Addala A, Buckingham B. Digital Technology for Diabetes. N Engl J Med 2023; 389:2076-2086. [PMID: 38048189 DOI: 10.1056/nejmra2215899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Affiliation(s)
- Michael S Hughes
- From the Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine (M.S.H.), and the Division of Pediatric Endocrinology, Department of Pediatrics (A.A., B.B), Stanford University, Stanford, CA
| | - Ananta Addala
- From the Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine (M.S.H.), and the Division of Pediatric Endocrinology, Department of Pediatrics (A.A., B.B), Stanford University, Stanford, CA
| | - Bruce Buckingham
- From the Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine (M.S.H.), and the Division of Pediatric Endocrinology, Department of Pediatrics (A.A., B.B), Stanford University, Stanford, CA
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Prahalad P, Maahs DM. Roadmap to Continuous Glucose Monitoring Adoption and Improved Outcomes in Endocrinology: The 4T (Teamwork, Targets, Technology, and Tight Control) Program. Diabetes Spectr 2023; 36:299-305. [PMID: 37982062 PMCID: PMC10654131 DOI: 10.2337/dsi23-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Glucose monitoring is essential for the management of type 1 diabetes and has evolved from urine glucose monitoring in the early 1900s to home blood glucose monitoring in the 1980s to continuous glucose monitoring (CGM) today. Youth with type 1 diabetes struggle to meet A1C goals; however, CGM is associated with improved A1C in these youth and is recommended as a standard of care by diabetes professional organizations. Despite their utility, expanding uptake of CGM systems has been challenging, especially in minoritized communities. The 4T (Teamwork, Targets, Technology, and Tight Control) program was developed using a team-based approach to set consistent glycemic targets and equitably initiate CGM and remote patient monitoring in all youth with new-onset type 1 diabetes. In the pilot 4T study, youth in the 4T cohort had a 0.5% improvement in A1C 12 months after diabetes diagnosis compared with those in the historical cohort. The 4T program can serve as a roadmap for other multidisciplinary pediatric type 1 diabetes clinics to increase CGM adoption and improve glycemic outcomes.
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Affiliation(s)
- Priya Prahalad
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
| | - David M. Maahs
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
- Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA
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Albanese-O’Neill A. Roadmap to the Effective Use of Continuous Glucose Monitoring by Diabetes Care and Education Specialists as Technology Champions. Diabetes Spectr 2023; 36:288-298. [PMID: 37982064 PMCID: PMC10654133 DOI: 10.2337/dsi23-0006] [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: 11/21/2023]
Abstract
This article describes the implementation of a diabetes technology educational program targeting continuous glucose monitoring (CGM) adoption that significantly increased utilization of CGM in the Division of Pediatric Endocrinology at the University of Florida. The author proposes that diabetes care and education specialists (DCESs) are uniquely positioned in the health care ecosystem to serve as diabetes technology champions. The article provides a step-by-step roadmap that DCESs and clinicians can use as they lead efforts to expand CGM adoption and durable use.
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Leadley C, Addala A, Berkeley J, Crocket H, Davis EA, Hewapathirana N, Hussain S, Lal R, Lomax K, Wilkinson T, de Bock M, Burckhardt MA. Following in Banting's footsteps or straying from the path? Observations from contemporary diabetes innovation. Front Endocrinol (Lausanne) 2023; 14:1270517. [PMID: 38033993 PMCID: PMC10686253 DOI: 10.3389/fendo.2023.1270517] [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: 07/31/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
While advancements in the treatment of diabetes continue to rapidly evolve, many of the newer technologies have financial barriers to care, opposing the egalitarian ethos of Banting who sold his patent on insulin for a nominal cost to allow it to be made widely available. Inequity in access to new therapies drives disparity in diabetes burden with potential for these gaps to widen in the future. The 2023 International Conference on Advanced Technologies and Treatments of Diabetes (ATTD) presented ground-breaking and current research in diabetes technology. Oral presentations of the ATTD conference 2023 were analyzed to describe what percentage of speakers discussed equity in their talks. Overall, less than a quarter of presenters discussed equity, though there was regional variation. To ensure that diabetes technologies reduce disparity and improve outcomes, we encourage future speakers at diabetes (technology) conferences to consider equity of diabetes care and incorporate this into their presentations.
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Affiliation(s)
- Connor Leadley
- Department of Pediatrics, University of Otago, Christchurch, New Zealand
| | - Ananta Addala
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, United States
- Stanford Diabetes Research Center, Stanford University, Stanford, United States
| | - Juliet Berkeley
- Department of Diabetes and Endocrinology, Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Hamish Crocket
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | - Elizabeth A. Davis
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, WA, Australia
- Children’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Division of Pediatrics within the Medical School, The University of Western Australia, Perth, WA, Australia
| | - Niranjala Hewapathirana
- Department of Diabetes and Endocrinology, Te Whatu Ora Waitaha, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Sufyan Hussain
- Department of Diabetes and Endocrinology, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust, London, United Kingdom
- Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King's College London, London, United Kingdom
- Institute of Diabetes, Endocrinology and Obesity, King’s Health Partners, London, United Kingdom
| | - Rayhan Lal
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, United States
- Stanford Diabetes Research Center, Stanford University, Stanford, United States
- Division of Endocrinology, Department of Medicine, Stanford University, Stanford, United States
| | - Kate Lomax
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, WA, Australia
- Children’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Thomas Wilkinson
- Department of Pediatrics, University of Otago, Christchurch, New Zealand
| | - Martin de Bock
- Department of Pediatrics, University of Otago, Christchurch, New Zealand
| | - Marie-Anne Burckhardt
- Pediatric Endocrinology and Diabetology, University Children’s Hospital, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Pihoker C, Shulman DI, Forlenza GP, Kaiserman KB, Sherr JL, Thrasher JR, Buckingham BA, Kipnes MS, Bode BW, Carlson AL, Lee SW, Latif K, Liljenquist DR, Slover RH, Dai Z, Niu F, Shin J, Jonkers RAM, Roy A, Grosman B, Vella M, Cordero TL, McVean J, Rhinehart AS, Vigersky RA. Safety and Glycemic Outcomes During the MiniMed TM Advanced Hybrid Closed-Loop System Pivotal Trial in Children and Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2023; 25:755-764. [PMID: 37782145 DOI: 10.1089/dia.2023.0255] [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] [Indexed: 10/03/2023]
Abstract
Background: During MiniMed™ advanced hybrid closed-loop (AHCL) use by adolescents and adults in the pivotal trial, glycated hemoglobin (A1C) was significantly reduced, time spent in range (TIR) was significantly increased, and there were no episodes of severe hypoglycemia or diabetic ketoacidosis (DKA). The present study investigated the same primary safety and effectiveness endpoints during AHCL use by a younger cohort with type 1 diabetes (T1D). Methods: An intention-to-treat population (N = 160, aged 7-17 years) with T1D was enrolled in a single-arm study at 13 investigational centers. There was a run-in period (∼25 days) using HCL or sensor-augmented pump with/without predictive low-glucose management, followed by a 3-month study period with AHCL activated at two glucose targets (GTs; 100 and 120 mg/dL) for ∼45 days each. The mean ± standard deviation values of A1C, TIR, mean sensor glucose (SG), coefficient of variation (CV) of SG, time at SG ranges, and insulin delivered between run-in and study were analyzed (Wilcoxon signed-rank test or t-test). Results: Compared with baseline, AHCL use was associated with reduced A1C from 7.9 ± 0.9% (N = 160) to 7.4 ± 0.7% (N = 136) (P < 0.001) and overall TIR increased from the run-in 59.4 ± 11.8% to 70.3 ± 6.5% by end of study (P < 0.001), without change in CV, time spent below range (TBR) <70 mg/dL, or TBR <54 mg/dL. Relative to longer active insulin time (AIT) settings (N = 52), an AIT of 2 h (N = 19) with the 100 mg/dL GT increased mean TIR to 73.4%, reduced TBR <70 mg/dL from 3.5% to 2.2%, and reduced time spent above range (TAR) >180 mg/dL from 28.7% to 24.4%. During AHCL use, there was no severe hypoglycemia or DKA. Conclusions: In children and adolescents with T1D, MiniMed AHCL system use was safe, A1C was lower, and TIR was increased. The lowest GT and shortest AIT were associated with the highest TIR and lowest TBR and TAR, all of which met consensus-recommended glycemic targets. ClinicalTrials.gov ID: NCT03959423.
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Affiliation(s)
- Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Dorothy I Shulman
- University of South Florida, Pediatric Diabetes and Endocrinology, Tampa, Florida, USA
| | - Gregory P Forlenza
- Department of Pediatrics, Barbara Davis Center of Childhood Diabetes, Aurora, Colorado, USA
| | | | - Jennifer L Sherr
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James R Thrasher
- Arkansas Diabetes and Endocrinology Center, Little Rock, Arkansas, USA
| | - Bruce A Buckingham
- Stanford University School of Medicine, Pediatric Diabetes and Endocrinology, Stanford, California, USA
| | - Mark S Kipnes
- Diabetes and Glandular Disease Clinic, San Antonio, Texas, USA
| | - Bruce W Bode
- Atlanta Diabetes Associates, Atlanta, Georgia, USA
| | - Anders L Carlson
- International Diabetes Center, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Scott W Lee
- Department of Endocrinology, Loma Linda University, Loma Linda, California, USA
| | - Kashif Latif
- AM Diabetes and Endocrinology Center, Bartlett, Tennessee, USA
| | | | - Robert H Slover
- Department of Pediatrics, Barbara Davis Center of Childhood Diabetes, Aurora, Colorado, USA
| | - Zheng Dai
- Medtronic, Northridge, California, USA
| | - Fang Niu
- Medtronic, Northridge, California, USA
| | - John Shin
- Medtronic, Northridge, California, USA
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Lu Y, Zhang Q, Wang X, Jiang Y, Xue Y. Usefulness of glucose management indicator derived from continuous glucose monitoring to assess glycemic condition in hospitalized patients with diabetic kidney disease treated with insulin pumps. J Diabetes Complications 2023; 37:108613. [PMID: 37769507 DOI: 10.1016/j.jdiacomp.2023.108613] [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: 05/29/2023] [Revised: 08/24/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND AND OBJECTIVE This study described the relationship of HbA1c and continuous glucose monitoring (CGM) derived glucose management indicator (CGM-derived GMI) and developed a model to estimate GMI based on clinical parameters (clinical-parameter GMI) for hospitalized DKD treated with insulin pump. METHODS This observational study collected clinical data of hospitalized DKD treated with insulin pump between February 2022 to February 2023. According to estimated glomerular filtration rate (eGFR), 156 participants were divided into G1-2 (n = 64), G3 (n = 56) and G4-5 (n = 36). Correlation between HbA1c and CGM-derived GMI was tested. Study population was divided into training and validation set based on ratio of 6:4. In training set, a linear model was established to calculate clinical-parameter GMI. In validation set, paired t-test and residual analysis was used to examine the difference between CGM-derived GMI and clinical-parameter GMI. RESULTS With renal function reduced, the correlation of HbA1c and CGM-derived GMI decreased. Meanwhile, as renal function reduced, the discordance between HbA1c and CGM-derived GMI decreased as well (P = 0.009). In training set, based on eGFR stages, anemia, albumin, FBG and HbA1c, formula to clinical-parameter GMI was established. In validation set, the differences between clinical-parameter GMI and CGM-derived GMI was around 0, with 95 % confidence interval of -1.8 % to 1.5 %. CONCLUSIONS HbA1c may be less accurate to reflect glycemic condition for DKD with impaired renal function. A easily accessiable model based on clinical parameter to estimate GMI may help assess glycemia for hospitalized DKD treated with insulin pump.
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Affiliation(s)
- Yi Lu
- Southern Medical University, Guangzhou, Guangdong 510,515, China
| | - Qian Zhang
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Xiangyu Wang
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Ya Jiang
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yaoming Xue
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
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Prahalad P, Hardison H, Odugbesan O, Lyons S, Alwazeer M, Neyman A, Miyazaki B, Cossen K, Hsieh S, Eng D, Roberts A, Clements MA, Ebekozien O. Benchmarking Diabetes Technology Use Among 21 U.S. Pediatric Diabetes Centers. Clin Diabetes 2023; 42:27-33. [PMID: 38230344 PMCID: PMC10788667 DOI: 10.2337/cd23-0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
The American Diabetes Association's Standards of Care in Diabetes recommends the use of diabetes technology such as continuous glucose monitoring systems and insulin pumps for people living with type 1 diabetes. Unfortunately, there are multiple barriers to uptake of these devices, including local diabetes center practices. This study aimed to examine overall change and center-to-center variation in uptake of diabetes technology across 21 pediatric centers in the T1D Exchange Quality Improvement Collaborative. It found an overall increase in diabetes technology use for most centers from 2021 to 2022 with significant variation.
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Affiliation(s)
- Priya Prahalad
- Stanford Children’s Health, Lucile Packard Children’s Hospital, Stanford, CA
| | | | | | - Sarah Lyons
- Baylor College of Medicine/Texas Children’s Hospital, Houston, TX
| | | | - Anna Neyman
- UH Rainbow Babies & Children’s Hospital, Cleveland, OH
| | | | | | - Susan Hsieh
- Cook Children’s, Endocrinology, Fort Worth, TX
| | - Donna Eng
- Pediatric Endocrinology, Spectrum Health, Helen DeVos Children’s Hospital, Grand Rapids, MI
| | | | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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Odugbesan O, Mungmode A, Rioles N, Buckingham D, Nelson G, Agarwal S, Grant A, Wright T, Hess E, Ebekozien O. Increasing Continuous Glucose Monitoring Use for Non-Hispanic Black and Hispanic People With Type 1 Diabetes: Results From the T1D Exchange Quality Improvement Collaborative Equity Study. Clin Diabetes 2023; 42:40-48. [PMID: 38230339 PMCID: PMC10788664 DOI: 10.2337/cd23-0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Despite the benefits of continuous glucose monitoring (CGM), there is lower use of this technology among non-Hispanic Black and Hispanic people with type 1 diabetes compared with their non-Hispanic White counterparts. The T1D Exchange Quality Improvement Collaborative recruited five endocrinology centers to pilot an equity-focused quality improvement (QI) study to reduce racial inequities in CGM use. The centers used rapid QI cycles to test and expand interventions such as provider bias training, translation of CGM materials, provision of CGM education in multiple languages, screening for social determinants of health, and shared decision-making. After implementation of these interventions, median CGM use increased by 7% in non-Hispanic White, 12% in non-Hispanic Black, and 15% in Hispanic people with type 1 diabetes. The gap between non-Hispanic White and non-Hispanic Black patients decreased by 5%, and the gap between non-Hispanic White and Hispanic patients decreased by 8%.
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Affiliation(s)
| | | | | | | | - Grace Nelson
- Le Bonheur Children’s Hospital, University of Tennessee, Memphis, TN
| | - Shivani Agarwal
- Albert Einstein College of Medicine–Montefiore Medical Center, Bronx, NY
| | - Amy Grant
- Cincinnati Children Hospital Medical Center, Columbus, OH
| | | | - Emilie Hess
- SUNY Upstate Medical University, Syracuse, NY
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi Medical Center School of Population Health, Jackson, MS
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Tindall LN, Xavier NA. Innovations in Diabetes Device Training: A Scoping Review. Endocr Pract 2023; 29:803-810. [PMID: 37290557 PMCID: PMC10245230 DOI: 10.1016/j.eprac.2023.05.012] [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: 03/16/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The coronavirus disease 2019 pandemic highlighted a pre-existing need for alternatives to traditional in-person diabetes device trainings. Barriers to care, which include the heavy burden of training, pose a threat to optimal adoption and utilization of these devices. We searched the literature for alternative methods of training, evaluated user satisfaction, and compared short-term clinical outcomes with guideline-based glucometric targets and historical training results. METHODS A scoping review of Embase articles from 2019 to 2021 was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines using key words relevant to diabetes technologies. Original full-text articles investigating training of new users on devices were included. Titles and abstracts were screened for eligibility by 2 independent reviewers, and results were summarized. RESULTS Of 25 articles retrieved from the database, 11 met the criteria. Alternative training strategies included video conferencing, phone calls, mobile applications, and hybrids with traditional trainings. Overall, there was a high degree of user satisfaction with virtual visits, with a preference for hybrid approaches (6 articles). Although glucometrics varied between articles, short-term glucometrics were satisfactory overall (8 articles), including improved glycated hemoglobin measurements and time in range. Two articles compared time in range over various time points after traditional and remote training. One found equivalency, and the other identified a 5% improvement with remote training. CONCLUSION Alternative training approaches are a viable option to reduce the barriers to care and to alleviate training burden. Intentional implementation of alternatives should be considered a solution to address current barriers.
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Affiliation(s)
- Lacie N Tindall
- Department of Connected Care, Eli Lilly and Company, Indianapolis, Indiana
| | - Neena A Xavier
- Department of Connected Care, Eli Lilly and Company, Indianapolis, Indiana.
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de Jongh D, Thom RL, Cronin AJ, Bunnik EM, Massey EK. Clinical Translation of Bio-Artificial Pancreas Therapies: Ethical, Legal and Psychosocial Interdisciplinary Considerations and Key Recommendations. Transpl Int 2023; 36:11705. [PMID: 37789914 PMCID: PMC10543913 DOI: 10.3389/ti.2023.11705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023]
Abstract
The field of regenerative medicine offers potential therapies for Type 1 Diabetes, whereby metabolically active cellular components are combined with synthetic medical devices. These therapies are sometimes referred to as "bioartificial pancreases." For these emerging and rapidly developing therapies to be clinically translated to patients, researchers must overcome not just scientific hurdles, but also navigate complex legal, ethical and psychosocial issues. In this article, we first provide an introductory overview of the key legal, ethical and psychosocial considerations identified in the existing literature and identify areas where research is currently lacking. We then highlight two principal areas of concern in which these discrete disciplines significantly overlap: 1) individual autonomy and 2) access and equality. Using the example of beta-cell provenance, we demonstrate how, by harnessing an interdisciplinary approach we can address these key areas of concern. Moreover, we provide practical recommendations to researchers, clinicians, and policymakers which will help to facilitate the clinical translation of this cutting-edge technology for Type 1 Diabetes patients. Finally, we emphasize the importance of exploring patient perspectives to ensure their responsible and acceptable translation from bench to body.
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Affiliation(s)
- Dide de Jongh
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Rebecca L. Thom
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College, London, United Kingdom
| | - Antonia J. Cronin
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College, London, United Kingdom
| | - Eline M. Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Emma K. Massey
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
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Ye Y, Acevedo Mendez BA, Izard S, Myers AK. Demographic Variables Associated With Diabetes Technology Awareness or Use in Adults With Type 2 Diabetes. Diabetes Spectr 2023; 37:60-64. [PMID: 38385093 PMCID: PMC10877207 DOI: 10.2337/ds23-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Background Studies in populations with type 1 diabetes highlight racial/ethnic disparities in the use of diabetes technology; however, little is known about disparities among those with type 2 diabetes. This project investigates the racial/ethnic and socioeconomic disparities in diabetes technology awareness and use in adults with type 2 diabetes in the ambulatory setting. Methods Adults ≥40 years of age with type 2 diabetes in ambulatory care were invited to participate via an e-mail link to a de-identified REDCap (Research Electronic Data Capture) questionnaire. Variables, including awareness and use of continuous glucose monitoring (CGM) and insulin pumps, were summarized descriptively using frequencies and percentages and were compared across racial/ethnic groups, education level, and income using Pearson χ2 or Fisher exact tests. Results The study included 116 participants, most of whom (62%) were White, elderly Medicare recipients. Compared with White participants, those of racially/ethnically minoritized groups were less likely to be aware of CGM (P = 0.013) or insulin pumps (P = 0.001). Participants with a high school education or less were also less likely to be aware of insulin pumps (P = 0.041). Interestingly, neither awareness nor use of CGM or insulin pumps was found to be associated with income. Conclusion This cross-sectional analysis suggests that racially/ethnically minoritized groups and individuals with lower education have less awareness of CGM or insulin pumps.
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Affiliation(s)
- Yuting Ye
- Department of Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Bernardo A. Acevedo Mendez
- Department of Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Stephanie Izard
- Quantitative Intelligence, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY
| | - Alyson K. Myers
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- Division of Endocrinology, Department of Medicine, Montefiore Einstein, Bronx, NY
- Albert Einstein College of Medicine, Bronx, NY
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Kompala T, Wong J, Neinstein A. Diabetes Specialists Value Continuous Glucose Monitoring Despite Challenges in Prescribing and Data Review Process. J Diabetes Sci Technol 2023; 17:1265-1273. [PMID: 35403469 PMCID: PMC10563522 DOI: 10.1177/19322968221088267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diabetes clinicians are key facilitators of continuous glucose monitoring (CGM) provision, but data on provider behavior related to CGM use and CGM generated data are limited. METHODS We conducted a national survey of providers caring for people with diabetes on CGM-related opinions, facilitators and barriers to prescription, and data review practices. RESULTS Of 182 survey respondents, 73.2% worked at academic centers, 70.6% were endocrinologists, and 70.7% practiced in urban settings. Nearly 70% of providers reported CGM use in the majority of their patients with type 1 diabetes. Half of the providers reported CGM use in 10% to 50% of their patients with type 2 diabetes. All respondents believed CGM improved quality of life and could optimize diabetes control. We found no differences in reported rates of CGM use based on providers' years of experience, patient volume, practice setting, or clinic type. Most providers reviewed CGM data each visit (97.7%) and actively involved patients in the data interpretation (98.8%). Only 14.1% of clinicians reported reviewing CGM data without any prompting from patients or their family members outside of visits. Most providers (80.7%) reported their CGM data review was valued by patients although only half reported having adequate time (45.1%) or an efficient process (56.1%) to do so. CONCLUSIONS Despite uniform support for CGM by providers, ongoing challenges related to cost, insurance coverage, and difficulties with prescription were major barriers to CGM use. Increased use of CGM in appropriate populations will necessitate improvements in data access and integration, clearly defined workflows, and decreased administrative burden to obtain CGM.
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Affiliation(s)
- Tejaswi Kompala
- Division of Endocrinology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jenise Wong
- Division of Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Aaron Neinstein
- Division of Endocrinology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA
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