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Rosli MA, Mohd Nasir NA, Mustafa MZ, Othman MA, Zakaria Z, Halim AS. Effectiveness of stingless bee (Kelulut) honey versus conventional gel dressing in diabetic wound bed preparation: A randomized controlled trial. J Taibah Univ Med Sci 2024; 19:209-219. [PMID: 38124990 PMCID: PMC10730855 DOI: 10.1016/j.jtumed.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 10/05/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose Kelulut honey contains trehalulose and has high antioxidant content, such as phenolic and flavonoid substances, which can promote wound healing. This study evaluated the effectiveness of Kelulut honey in diabetic wound healing compared to a commercially available conventional gel dressing (Intrasite gel). Methods A prospective, randomized, single-blinded control trial was performed on eligible diabetic patients with full-thickness cavity wounds. Patients' demographics, size and site of wounds, and baseline routine blood investigations were recorded. The wounds were dressed every other day with Kelulut honey for the intervention group or gel for the control group. The wound size reduction and granulation tissue formation percentage were calculated every 6 days for 1 month. Results Seventy-one patients were randomized. After 30 days of follow-up, 62 participants were available for analysis: 30 from the control group and 32 from the treatment group. The control group had increased granulation tissue at baseline and more wounds on the lower limb and posterior trunk. Both groups showed an increasing mean and median percentage of wound epithelialization and granulation tissue over time, with significantly higher values at every timepoint in the honey group (p < 0.05). However, repeated measures analysis of variance and analysis of covariance revealed no significant interaction effect between the different treatments and time, with F (2.02, 121.28) = 0.88, p = 0.417 and F (1.60, 93.95) = 0.79, p = 0.431, respectively. Conclusion This study revealed that Kelulut honey was comparable to and as effective as the conventional gel in treating diabetic wounds in terms of promoting epithelialization and granulation tissue formation.
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Affiliation(s)
- Mohamad A. Rosli
- Reconstructive Sciences Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Nur A. Mohd Nasir
- Reconstructive Sciences Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Mohd Z. Mustafa
- Department of Neurosciences, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Muhammad A. Othman
- Enterostomal Therapy Unit, Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu Kelantan, Malaysia
- Department of Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Zaidi Zakaria
- Enterostomal Therapy Unit, Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu Kelantan, Malaysia
- Department of Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Ahmad S. Halim
- Reconstructive Sciences Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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Bergenstal RM, Bode BW, Bhargava A, Wang Q, Knights AW, Chang AM. Assessing Time in Range with Postprandial Glucose-Focused Titration of Ultra Rapid Lispro (URLi) in People with Type 1 Diabetes. Diabetes Ther 2023; 14:1933-1945. [PMID: 37740871 PMCID: PMC10570246 DOI: 10.1007/s13300-023-01476-4] [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: 07/17/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023] Open
Abstract
INTRODUCTION To assess time in range (TIR) (70-180 mg/dL) with postprandial glucose (PPG)-focused titration of ultra rapid lispro (URLi; Lyumjev®) in combination with insulin degludec in people with type 1 diabetes (T1D). METHODS This phase 2, single-group, open-label, exploratory study was conducted in 31 participants with T1D on multiple daily injection therapy. Participants were treated with insulin degludec and Lispro for an 11-day lead-in and then URLi for a 46-day treatment period consisting of 35-day titration and 11-day endpoint maintenance period. Glucose targets for the titration period were PPG < 140 mg/dL or < 20% increase from premeal, fasting glucose 80-110 mg/dL, and overnight excursion ± 30 mg/dL or less. Participants used the InPen™ bolus calculator and Dexcom G6 continuous glucose monitoring (CGM). RESULTS Primary endpoint mean TIR (70-180 mg/dL) with URLi during the maintenance period was 70.2%. TIR (70-180 mg/dL) and times below/above range were not significantly different with URLi (maintenance) versus lispro (lead-in). HbA1c decreased from 7.1% at screening to 6.8% at endpoint (least squares mean [LSM] change from baseline, - 0.36%; P < 0.001). Fructosamine and 1,5-anhydroglucitol improved (P < 0.001). Mean hourly glucose using CGM was reduced from 8:00 AM to 4:00 PM with URLi. Overall highest PPG excursion across meals was significantly reduced at URLi endpoint compared with lispro lead-in (mean 56.5 vs 72.4 mg/dL; P < 0.001). Insulin-to-carbohydrate ratio (U/X g) was reduced (more insulin given) at breakfast at URLi endpoint vs lead-in (LSM 9.0 vs 9.7 g; P = 0.002) and numerically decreased at other meals. Total daily insulin dose (TDD) was higher at URLi endpoint compared with lispro lead-in (mean 50.2 vs 47.0 U; P = 0.046) with similar prandial/TDD ratio (mean 52.1% vs 51.2%). There were no severe hypoglycemia events during the study. CONCLUSIONS URLi in a basal-bolus regimen focusing on PPG targets demonstrated improved overall glycemic control and reduced PPG excursions without increased hypoglycemia in participants with T1D. TRIAL REGISTRATION ClinicalTrial.gov, NCT04585776.
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Affiliation(s)
| | - Bruce W Bode
- Atlanta Diabetes Associates Hospital, Atlanta, GA, USA
| | - Anuj Bhargava
- Iowa Diabetes and Endocrinology Research Center, West Des Moines, IA, USA
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Ampudia‐Blasco FJ, Duque N, Artime E, Caveda E, Spaepen E, Díaz‐Cerezo S, de Santos MR, Velasco DC, Bahíllo‐Curieses MP. Which people with diabetes are treated with a disposable, half-unit insulin pen? A real-world, retrospective, database study in Spain. Endocrinol Diabetes Metab 2023; 6:e451. [PMID: 37715339 PMCID: PMC10638621 DOI: 10.1002/edm2.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/02/2023] [Indexed: 09/17/2023] Open
Abstract
INTRODUCTION Insulin lispro 100 units/mL Jr KwikPen is the first prefilled, disposable, half-unit insulin pen that delivers 0.5-30 units in increments of 0.5 units for the treatment of patients with diabetes. This study describes the profile of patients in Spain who initiated insulin therapy with Jr KwikPen in a real-world setting. METHODS This retrospective, observational study based on IQVIA's electronic medical records database included patients with Type 1 (T1D) or Type 2 (T2D) diabetes who initiated therapy with Jr KwikPen between May 2018 and December 2020. Sociodemographic, clinical, and treatment characteristics at treatment initiation were analysed descriptively. RESULTS A total of 416 patients were included. The main characteristics of the T1D/T2D groups (N = 326/90), respectively were as follows: female sex, 61.7%/65.6%; mean age (standard deviation [SD]), 32.5 (20.7)/55.5 (16.6) years; body mass index, 20.9 (4.2)/25.2 (4.6) kg/m2 (N = 239/77); HbA1c, 7.8 (1.7)%/8.0 (1.5)% (N = 141/64); and presence of diabetes-associated comorbidities, 27.9%/64.4%. Only 32.8% of patients with T1D were < 18 years old. Among Jr KwikPen users, 12.3% (T1D/T2D, 7.7%/28.9%) were ≥ 65 years old, 17.1% patients were newly diagnosed, and 3.8% were pregnant women. The mean (SD) total insulin dose pre-index for T1D/T2D was 43.1 (23.6) and 40.7 (21.6) UI/day, respectively. The mean (SD) insulin dose at the start of Jr KwikPen use was 26.63 (16.56) and 22.58 (13.59) UI/day for T1D/T2D, respectively. Jr KwikPen was first prescribed mainly by endocrinologists (58.7%) or paediatricians (22.6%). CONCLUSIONS The profile of patients who initiated therapy with Jr KwikPen in routine practice was broad with many patients being adults. Most of these patients had T1D, inadequate glycemic control, and multiple associated comorbidities. These results suggest that Jr KwikPen is prescribed in patients who may benefit from finer insulin dose adjustments, namely children, adolescents, adults, older individuals, or pregnant women with T1D or T2D.
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Affiliation(s)
- F. Javier Ampudia‐Blasco
- Endocrinology and Nutrition DepartmentClinic University Hospital Valencia, INCLIVA Research FoundationValenciaSpain
| | | | | | | | | | | | | | | | - M. Pilar Bahíllo‐Curieses
- Servicio de Pediatría, Endocrinología Pediátrica, Hospital Clínico Universitario de ValladolidValladolidSpain
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Bailey TS, Bode BW, Wang Q, Knights AW, Chang AM. Increased Time in Range with Ultra Rapid Lispro Treatment in Participants with Type 2 Diabetes: PRONTO-Time in Range. Diabetes Ther 2023; 14:883-897. [PMID: 37029268 PMCID: PMC10081815 DOI: 10.1007/s13300-023-01400-w] [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: 02/09/2023] [Accepted: 03/22/2023] [Indexed: 04/09/2023] Open
Abstract
INTRODUCTION To evaluate time in range metrics and HbA1c in people with type 2 diabetes (T2D) treated with ultra rapid lispro (URLi) using continuous glucose monitoring (CGM) for the first time in this population. METHODS This was a Phase 3b, 12-week, single-treatment study in adults with T2D on basal-bolus multiple daily injection (MDI) therapy using basal insulin glargine U-100 along with a rapid-acting insulin analog. Following a 4-week baseline period, 176 participants were newly treated with prandial URLi. Participants used unblinded CGM (Freestyle Libre). Primary endpoint was time in range (TIR) (70-180 mg/dl) during the daytime period at Week 12 compared to baseline with gated secondary endpoints of HbA1c change from baseline and 24-h TIR (70-180 mg/dl). RESULTS Improved glycemic control was observed at Week 12 versus baseline including mean daytime TIR (change from baseline [Δ] 3.8%; P = 0.007), HbA1c (Δ - 0.44%; P < 0.001), and 24-h TIR (Δ 3.3%; P = 0.016) with no significant difference in time below range (TBR). After 12 weeks, there was a statistically significant decrease in postprandial glucose incremental area under curve, overall, across all meals, within 1 h (P = 0.005) or 2 h (P < 0.001) after the start of a meal. Basal, bolus, and total insulin dose were intensified with increased bolus/total dose ratio at Week 12 (50.7%) versus baseline (44.5%; P < 0.001). There were no severe hypoglycemia events during the treatment period. CONCLUSIONS In people with T2D, URLi in an MDI regimen was efficacious with improved glycemic control including TIR, HbA1c, and postprandial glucose without increased hypoglycemia/TBR. CLINICAL TRIAL REGISTRATION NUMBER: NCT04605991.
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Affiliation(s)
| | - Bruce W Bode
- Atlanta Diabetes Associates Hospital, Atlanta, GA, USA
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5
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The prevalence and risk factors of retinopathy and nephropathy in prediabetic population. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Underwood P, Hibben J, Gibson J, DiNardo M. Virtual visits and the use of continuous glucose monitoring for diabetes care in the era of COVID-19. J Am Assoc Nurse Pract 2022; 34:586-596. [PMID: 34907992 PMCID: PMC8893130 DOI: 10.1097/jxx.0000000000000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 10/19/2022]
Abstract
ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic has led to an increase in virtual care utilization for patients with diabetes mellitus (DM). Virtual DM care requires both providers and patients to become familiar with new technology that supports home health monitoring. Continuous glucose monitoring (CGM) is a DM technology that provides 24-hr glucose monitoring and is associated with improved clinical outcomes, including decreased rates of hypoglycemia and lower hemoglobin A1c (A1c). Continuous glucose monitoring use has increased due to ease of use and its ability to allow patients to share data with providers during virtual visits. Although the clinical benefits of CGM use are clear, many providers are overwhelmed by the various options available and large influx of data received. The purpose of this clinical case review is to provide an overview of CGM use in the virtual care setting. Various types of CGMs will be defined and an overview of the patient characteristics shown to benefit most from CGM use will be provided. Further, recommendations for improving clinic workflow when using CGM will be outlined, including strategies to handle the influx of large datasets, outlining the role of the nurse practitioner (NP) and other providers in the clinic, and organizing data for efficient and improved clinical decision making. Continuous glucose monitoring use is hallmarked to revolutionize DM care for many patients, particularly during and after the COVID-19 pandemic. It is important that clinicians understand the nuances of CGM use and organize their virtual clinics to efficiently manage CGM users, leading to improved clinical decisions and patient outcomes.
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Affiliation(s)
- Patricia Underwood
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
- Endocrine Section, Department of Medicine, Veterans Health Administration (VHA) System, Boston, Massachusetts
| | - Jennifer Hibben
- Endocrine Section, Department of Medicine, Veterans Health Administration (VHA) System, Boston, Massachusetts
| | - Jolynn Gibson
- Endocrine Section, Department of Medicine VA Pittsburgh, Pittsburgh, Pennsylvania
| | - Monica DiNardo
- Endocrine Section, Department of Medicine VA Pittsburgh, Pittsburgh, Pennsylvania
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Naikoo GA, Awan T, Salim H, Arshad F, Hassan IU, Pedram MZ, Ahmed W, Faruck HL, Aljabali AAA, Mishra V, Serrano‐Aroca Á, Goyal R, Negi P, Birkett M, Nasef MM, Charbe NB, Bakshi HA, Tambuwala MM. Fourth-generation glucose sensors composed of copper nanostructures for diabetes management: A critical review. Bioeng Transl Med 2022; 7:e10248. [PMID: 35111949 PMCID: PMC8780923 DOI: 10.1002/btm2.10248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 01/31/2023] Open
Abstract
More than five decades have been invested in understanding glucose biosensors. Yet, this immensely versatile field has continued to gain attention from the scientific world to better understand and diagnose diabetes. However, such extensive work done to improve glucose sensing devices has still not yielded desirable results. Drawbacks like the necessity of the invasive finger-pricking step and the lack of optimization of diagnostic interventions still need to be considered to improve the testing process of diabetic patients. To upgrade the glucose-sensing devices and reduce the number of intermediary steps during glucose measurement, fourth-generation glucose sensors (FGGS) have been introduced. These sensors, made using robust electrocatalytic copper nanostructures, improve diagnostic efficiency and cost-effectiveness. This review aims to present the essential scientific progress in copper nanostructure-based FGGS in the past 10 years (2010 to present). After a short introduction, we presented the working principles of these sensors. We then highlighted the importance of copper nanostructures as advanced electrode materials to develop reliable real-time FGGS. Finally, we cover the advantages, shortcomings, and prospects for developing highly sensitive, stable, and specific FGGS.
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Affiliation(s)
- Gowhar A. Naikoo
- Department of Mathematics and SciencesCollege of Arts and Applied Sciences, Dhofar UniversitySalalahOman
| | - Tasbiha Awan
- Department of Mathematics and SciencesCollege of Arts and Applied Sciences, Dhofar UniversitySalalahOman
| | - Hiba Salim
- Department of Mathematics and SciencesCollege of Arts and Applied Sciences, Dhofar UniversitySalalahOman
| | - Fareeha Arshad
- Department of BiochemistryAligarh Muslim UniversityAligarhIndia
| | | | - Mona Zamani Pedram
- Faculty of Mechanical Engineering—Energy DivisionK.N. Toosi University of TechnologyTehranIran
| | - Waqar Ahmed
- School of Mathematics and PhysicsCollege of Science, University of LincolnLincolnUK
| | | | - Alaa A. A. Aljabali
- Departmnt of Pharmaceutics and Pharmaceutical TechnologyYarmouk UniversityIrbidJordan
| | - Vijay Mishra
- School of Pharmaceutical SciencesLovely Professional UniversityPhagwaraPunjabIndia
| | - Ángel Serrano‐Aroca
- Biomaterials and Bioengineering LabTranslational Research Centre San Alberto Magno, Catholic University of Valencia San Vicente MártirValenciaSpain
| | - Rohit Goyal
- School of Pharmaceutical SciencesShoolini University of Biotechnology and Management SciencesSolanIndia
| | - Poonam Negi
- School of Pharmaceutical SciencesShoolini University of Biotechnology and Management SciencesSolanIndia
| | - Martin Birkett
- Department of Mechanical and Construction EngineeringNorthumbria UniversityNewcastle upon TyneUK
| | - Mohamed M. Nasef
- Department of PharmacySchool of Applied Science, University of HuddersfieldUK
| | - Nitin B. Charbe
- Department of Pharmaceutical SciencesRangel College of Pharmacy, Texas A&M UniversityKingsvilleTexasUSA
| | - Hamid A. Bakshi
- School of Pharmacy and Pharmaceutical ScienceUlster UniversityColeraineUK
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Huang W, Wei W, Wang J, Lyu Y, Li L. Effectiveness of a nurse-led online educational programme based on basic insulin therapy in patients with diabetes mellitus: A quasi-experimental trial. J Clin Nurs 2021; 31:2227-2239. [PMID: 34558147 DOI: 10.1111/jocn.16041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/14/2021] [Accepted: 08/26/2021] [Indexed: 01/19/2023]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of a nurse-led online educational programme based on patients with diabetes mellitus treated with initial basal insulin therapy. BACKGROUND Patients with type 2 diabetes mellitus (T2DM) need to be treated with insulin to control hyperglycaemia and reduce the risk of diabetic complications when oral hypoglycaemic drugs are not effective or contraindicated. Current practices emphasise the leading role of nurses in patients treated with initial basal insulin therapy after discharge. The introduction of nurse-led online education within this area is a relatively new programme. DESIGN This study was a quasi-experimental, nonequivalent, two-group, comparison group design. METHODS The study selected 800 patients with T2DM hospitalised in the Department of Endocrinology at a Chinese hospital from July 2018 to June 2020 who were initially treated with insulin. According to the time sequence, 400 patients from July 2018 to June 2019 were divided into the control group and 400 patients from July 2019 to June 2020 into the intervention group. The control group received routine health education and doctor-led follow-up based on routine health education. The intervention group received systematic health education and online insulin injection activities led by nurses. The effects were evaluated after 3 and 6 months of intervention. The TREND checklist was followed to ensure rigour in the study. RESULTS In total, 339 patients were enrolled in the intervention group and 333 patients within the control group. According to the analysis, 3 months after the intervention, the compliance rate of fasting blood glucose (FBG) (rate difference: 0.078, 95% CI: 0.006-1.150, p < .05) and HbA1c (%) (rate difference: 0.070, 95% CI: 0.001-0.137, p < .05) between the intervention and control groups were statistically significant; 6 months after the intervention, the compliance rate of FBG (rate difference: 0.077, 95% CI: 0.007-0.14, p < .05) and HbA1c (%) (rate difference: 0.106, 95% CI: 0.324-0.180, p < .01) between the intervention and the control groups were statistically significant. The total score of the 'My Opinion on Insulin' scale in the intervention group was (80.18 ± 6.68), and in the control group was (71.15 ± 8.17), there was a significant difference in the scale between the two groups (mean difference: 9.03, 95% CI: 7.900-10.160, p < .01). Through a multivariable regression model, in order to correct the important baseline characteristics, the daily insulin dosage, and the total score of the 'My Opinion on Insulin' scale after 6 months of intervention were independent risk factors for the two intervention methods in diabetic patients treated with initial basal insulin therapy (p < .05). CONCLUSIONS A nurse-led online programme was feasible and effective for patients with diabetes mellitus treated with initial basal insulin therapy. This programme could effectively be used to reduce the patient's daily insulin dose, as well as improve the patients' compliance using insulin therapy. RELEVANCE TO CLINICAL PRACTICE Nurse-led online education has a role in implementing a safe, standardised, and sustained approach to patients with diabetes mellitus treated with initial basal insulin therapy during follow-up after discharge.
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Affiliation(s)
- Wenzhen Huang
- Department of Endocrinology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No.7 Weiwu Street, Zhengzhou, 450000, China
| | - Wei Wei
- Department of Endocrinology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No.7 Weiwu Street, Zhengzhou, 450000, China
| | - Jie Wang
- Department of Endocrinology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No.7 Weiwu Street, Zhengzhou, 450000, China
| | - Yinghua Lyu
- Department of Endocrinology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No.7 Weiwu Street, Zhengzhou, 450000, China
| | - Li Li
- Department of Endocrinology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No.7 Weiwu Street, Zhengzhou, 450000, China
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9
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Forst T, Choudhary P, Schneider D, Linetzky B, Pozzilli P. A practical approach to the clinical challenges in initiation of basal insulin therapy in people with type 2 diabetes. Diabetes Metab Res Rev 2021; 37:e3418. [PMID: 33098260 PMCID: PMC8519070 DOI: 10.1002/dmrr.3418] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/17/2020] [Accepted: 08/09/2020] [Indexed: 12/18/2022]
Abstract
Initiating insulin therapy with a basal insulin analogue has become a standard of care in the treatment of type 2 diabetes mellitus (T2DM). Despite increasing choices in pharmacological approaches, intensified glucose monitoring and improvements in quality of care, many patients do not achieve the desired level of glycaemic control. Although insulin therapy, when optimized, can help patients reach their glycaemic goals, there are barriers to treatment initiation on both the side of the patient and provider. Providers experience barriers based on their perceptions of patients' capabilities and concerns. They may lack the confidence to solve the practical problems of insulin therapy and avoid decisions they perceive as risky for their patients. In this study, we review recommendations for basal insulin initiation, focussing on glycaemic targets, titration, monitoring, and combination therapy with non-insulin anti-hyperglycaemic medications. We provide practical advice on how to address some of the key problems encountered in everyday clinical practice and give recommendations where there are gaps in knowledge or guidelines. We also discuss common challenges faced by people with T2DM, such as weight gain and hypoglycaemia, and how providers can address and overcome them.
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Affiliation(s)
- Thomas Forst
- Department of Endocrinology and Metabolic DiseasesUniversitatsmedizin der Johannes GutenbergMainzGermany
- Clinical Research ServicesManhheimGermany
| | - Pratik Choudhary
- Department of Diabetes and Nutritional SciencesKing's CollegeLondonUK
| | | | | | - Paolo Pozzilli
- Department of Endocrinology and Metabolic DiseasesUniversità Campus Bio‐MedicoRomeItaly
- Centre of ImmunobiologyBarts and the London School of MedicineQueen Mary University of LondonUK
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Abstract
The ambulatory glucose profile (AGP) and the frequency distribution for glucose by ranges are well established as standard methods for display, analysis, and interpretation of glucose data arising from self-monitoring, continuous glucose monitoring, and automated insulin delivery systems. In this review, we consider several refinements that may further improve the utility of the AGP. These include (1) display of the AGP together with information regarding dietary intake, medication administration (e.g., insulin), glucose lowering (pharmacodynamic) activity of medications, and physical activity measured by accelerometers or heart rate; (2) display of average time below range (%TBR), time above range (%TAR), and time in range (%TIR) by time of day to indicate timing of hypoglycemic and hyperglycemic episodes; (3) detailed analysis of postprandial excursions for each of the major meals after synchronizing by onset of meals and adjusting for the premeal glucose levels, enabling comparisons of magnitude, shape, and patterns; (4) methods to characterize distinct patterns on different days of the week; (5) display of glucose on a nonlinear scale to improve the balance between deviations associated with hypoglycemia versus hyperglycemia; (6) use of time scales other than midnight-to-midnight to facilitate analysis of time segments of particular interest (e.g., overnight); (7) options to display individual glucose values to assist in the identification of dates and times of outliers and episodes of hypoglycemia and hyperglycemia; and (8) methods to compare AGPs obtained from different individuals or groups receiving alternative interventions in terms of therapy or technology. These refinements, individually or collectively, can potentially further enhance the effectiveness of the AGP for assessment of glucose levels, patterns, and variability. We discuss several questions regarding implementation and optimization of these methods.
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Affiliation(s)
- David Rodbard
- Biomedical Informatics Consultants LLC, Potomac, Maryland, USA
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11
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Abstract
The hybrid closed-loop (HCL) system has been shown to improve glycemic control and reduce hypoglycemia. Optimization of HCL settings requires interpretation of the glucose, insulin, and factors affecting glucose such as food intake and exercise. To the best of our knowledge, there is no published guidance on the standardized reporting of HCL systems. Standardization of HCL reporting would make interpretation of data easy across different systems. We reviewed the literature on patient and provider perspectives on downloading and reporting glucose metric preferences. We also incorporated international consensus on standardized reporting for glucose metrics. We describe a single-page HCL data reporting, referred to here as "artificial pancreas (AP) Dashboard." We propose seven components in the AP Dashboard that can provide detailed information and visualization of glucose, insulin, and HCL-specific metrics. The seven components include (A) glucose metrics, (B) hypoglycemia, (C) insulin, (D) user experience, (E) hyperglycemia, (F) glucose modal-day profile, and (G) insight. A single-page report similar to an electrocardiogram can help providers and patients interpret HCL data easily and take the necessary steps to improve glycemic outcomes. We also describe the optimal sampling duration for HCL data download and color coding for visualization ease. We believe that this is a first step in creating a standardized HCL reporting, which may result in better uptake of the systems. For increased adoption, standardized reporting will require input from providers, patients, diabetes device manufacturers, and regulators.
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Affiliation(s)
- Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Satish K Garg
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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12
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Bue-Valleskey J, Klaff L, Cho JI, Dellva MA, Schloot NC, Tobian J, Miura J, Dahl D. Long-Term Efficacy and Safety of Ultra Rapid Lispro (URLi) in Adults with Type 1 Diabetes: The PRONTO-T1D Extension. Diabetes Ther 2021; 12:569-580. [PMID: 33458803 PMCID: PMC7846637 DOI: 10.1007/s13300-020-00987-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/15/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The PRONTO-T1D study, which evaluated the efficacy and safety of ultra rapid lispro (URLi) versus lispro in adults with type 1 diabetes (T1D), met the primary endpoint of noninferiority of HbA1c change from baseline compared to lispro at 26 weeks. We present results of an additional 26-week treatment phase evaluating long-term efficacy and safety of URLi. METHODS In this phase 3, treat-to-target study, subjects were randomized to double-blind mealtime URLi, lispro, or open-label postmeal URLi with insulin degludec or glargine for 26 weeks. Subjects in the double-blind URLi (n = 451) and lispro (n = 442) groups continued for another 26 weeks to assess long-term efficacy and safety. RESULTS HbA1c increased marginally during the long-term maintenance period (week 26-52) in both groups to 7.47% (URLi) and 7.54% (lispro). At week 52, there were no statistically significant treatment differences in change from baseline HbA1c with a least-squares mean treatment difference (95% confidence interval) of - 0.06% (- 0.16, 0.03). Proportions of patients with HbA1c < 7% at week 52 were similar (URLi, 26.8%; lispro, 24.5%). Self-monitored blood glucose (SMBG) showed that 1-h (9.23 versus 10.14 mmol/L) and 2-h (8.40 versus 9.53 mmol/L) postmeal daily mean glucose was statistically significantly (p < 0.001) lower with URLi than lispro. The rate and incidence of severe, documented, and postprandial hypoglycemia (< 54 mg/dl [3.0 mmol/L]) were similar between treatments, but URLi demonstrated a 31% lower rate in the period more than 4 h after meals, (p = 0.023). Injection site reactions were reported by 3.3% of patients on URLi and 0.9% on lispro. The incidence of treatment-emergent adverse events was similar between treatments. CONCLUSION Overall glycemic control and improved postprandial glucose via SMBG were maintained after 52 weeks with URLi versus lispro, suggesting that the efficacy of URLi is preserved during long-term treatment in patients with T1D. No long-term safety issues were identified with URLi. TRIAL REGISTRATION ClinicalTrials.gov, NCT03214367.
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Affiliation(s)
| | - Leslie Klaff
- Rainier Clinical Research Center, Renton, WA, USA
| | - Jang Ik Cho
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Mary Anne Dellva
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | | | - Janet Tobian
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Junnosuke Miura
- Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Dominik Dahl
- Gemeinschaftspraxis fur Innere Medizin und Diabetologie, Hamburg, Germany
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13
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Tao J, Gao L, Liu Q, Dong K, Huang J, Peng X, Yang Y, Wang H, Yu X. Factors contributing to glycemic control in diabetes mellitus patients complying with home quarantine during the coronavirus disease 2019 (COVID-19) epidemic. Diabetes Res Clin Pract 2020; 170:108514. [PMID: 33068663 PMCID: PMC7558228 DOI: 10.1016/j.diabres.2020.108514] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 01/10/2023]
Abstract
AIMS This study assessed factors contributing to glycemic control among diabetes mellitus patients complying with home quarantine during the epidemic of coronavirus disease 2019 (COVID-19). METHODS We conducted an analytical cross-sectional study by telephone with 1159 patients with type 2 diabetes mellitus (T2DM) and 96 patients with type 1 diabetes mellitus (T1DM) who were discharged from the endocrinology department of a hospital from January 1, 2019, to January 24, 2020. According to their fasting blood glucose (FBG) and 2-h postprandial BG (2hPBG) values, the patients were divided into the well-controlled BG group and the poorly controlled BG group. The main evaluation indicators included sociodemographic variables, health risk variables and adherence to self-management behaviors. RESULTS In total, 74.46% of the T2DM patients and 64.89% of the T1DM patients had poor glycemic control. T2DM patients with poor glycemic control were more likely to be older (odds ratio (OR): 1.017 [95% confidence interval (CI) 1.003-1.030]; P = 0.013), have fewer than 12 years of education (OR: 1.646 [95% CI 1.202-2.255]; P = 0.002), lack a BG meter at home (OR: 2.728 [95% CI 1.205-6.179]; P = 0.016), have a lower degree of medicationcompliance (OR: 1.627 [95% CI 1.076-2.460]; P = 0.021), and engage in less self-monitoring of BG (SMBG) per week (OR: 10.884 [95% CI 5.883-20.139]; P < 0.001). Fewer than 12 years of education (OR: 3.031 [95% CI 1.112-8.263]; P = 0.030) was a risk factor for glycemic control in T1DM. CONCLUSIONS Glycemic control among patients with T1DM and T2DM during home quarantine amid the COVID-19 pandemic is poor. Our results showed that more eduction, a higher frequency of SMBG, and improved medication compliance may contribute to glycemic control. Therefore, diabetic patients should be advised to increase the frequency of blood glucose measurements during home quarantine and be re-educated regarding the importance of medication compliance.
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Affiliation(s)
- Jing Tao
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Lianlian Gao
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Qinghua Liu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Kun Dong
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Jiaojiao Huang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xuemin Peng
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Yan Yang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xuefeng Yu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Heinemann L, Klonoff DC. An Opportunity to Increase the Benefit of CGM Usage: The Need to Train the Patients Adequately. J Diabetes Sci Technol 2020; 14:983-986. [PMID: 31876181 PMCID: PMC7645144 DOI: 10.1177/1932296819895083] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Lutz Heinemann
- Science & Co, Neuss, Germany
- Lutz Heinemann, PhD, Science Consulting in Diabetes GmbH, Schwerinstr. 50, 41462 Neuss, Germany.
| | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
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15
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Pedone E, Laurenzi A, Allora A, Bolla AM, Caretto A. Insulin pump therapy and continuous glucose monitoring in adults with type 2 diabetes: where are we now? EXPLORATION OF MEDICINE 2020. [DOI: 10.37349/emed.2020.00021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Technology in diabetes is rapidly evolving, with the aim of helping affected people to safely optimize their blood glucose control. New technologies are now considered as an essential tool for managing glycemia predominantly in people with type 1 diabetes, and clinical trials have demonstrated that in these subjects the use of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems are associated with improved glycemic control along with a better quality of life. Literature regarding technologies and type 2 diabetes is relatively lacking, but innovations may have an important role also in the management of these patients. Some studies in adults with type 2 diabetes have shown benefits with the use of CGM in terms of glycemic variability and improved therapeutic adjustments. Clinical trials about CSII and CGM use in type 2 diabetes may have some pitfalls and future studies are needed to assess how these advanced systems could improve clinical outcomes and also ensure cost-effectiveness in this population. In this narrative review, we aim to highlight the most relevant studies on this topic and to focus on the potential role of new technological devices in type 2 diabetes management.
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Affiliation(s)
- Erika Pedone
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Andrea Laurenzi
- Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Agnese Allora
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Andrea Mario Bolla
- Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Amelia Caretto
- Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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16
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Grunberger G. Continuous glucose monitoring: Musing on our progress in memory of Dr Andrew Jay Drexler. J Diabetes 2020; 12:772-774. [PMID: 32162454 DOI: 10.1111/1753-0407.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- George Grunberger
- Grunberger Diabetes Institute, Bloomfield Hills, Michigan, USA
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- First Faculty of Medicine, Charles University, Prague, Czech Republic
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17
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Klaff L, Cao D, Dellva MA, Tobian J, Miura J, Dahl D, Lucas J, Bue‐Valleskey J. Ultra rapid lispro improves postprandial glucose control compared with lispro in patients with type 1 diabetes: Results from the 26-week PRONTO-T1D study. Diabetes Obes Metab 2020; 22:1799-1807. [PMID: 32488923 PMCID: PMC7539952 DOI: 10.1111/dom.14100] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 12/23/2022]
Abstract
AIMS To evaluate the efficacy and safety of ultra rapid lispro (URLi) versus lispro in adults with type 1 diabetes in a 26-week, treat-to-target, phase 3 trial. MATERIALS AND METHODS After an 8-week lead-in to optimize basal insulin glargine or degludec, patients were randomized to double-blind mealtime URLi (n = 451) or lispro (n = 442), or open-label post-meal URLi (n = 329). The primary endpoint was change from baseline glycated haemoglobin (HbA1c) to 26 weeks (non-inferiority margin 0.4%), with multiplicity-adjusted objectives for postprandial glucose (PPG) excursions after a meal test. RESULTS Both mealtime and post-meal URLi demonstrated non-inferiority to lispro for HbA1c: estimated treatment difference (ETD) for mealtime URLi -0.08% [95% confidence interval (CI) -0.16, 0.00] and for post-meal URLi +0.13% (95% CI 0.04, 0.22), with a significantly higher endpoint HbA1c for post-meal URLi versus lispro (P = 0.003). Mealtime URLi was superior to lispro in reducing 1- and 2-hour PPG excursions during the meal test: ETD -1.55 mmol/L (95% CI -1.96, -1.14) at 1 hour and - 1.73 mmol/L (95% CI -2.28, -1.18) at 2 hours (both P < 0.001). The rate and incidence of severe, documented and postprandial hypoglycaemia (<3.0 mmol/L) was similar between treatments, but mealtime URLi demonstrated a 37% lower rate in the period >4 hours after meals (P = 0.013). Injection site reactions were reported by 2.9% of patients on mealtime URLi, 2.4% on post-meal URLi, and 0.2% on lispro. Overall, the incidence of treatment-emergent adverse events was similar between treatments. CONCLUSIONS The results showed that URLi provided good glycaemic control, with non-inferiority to lispro confirmed for both mealtime and post-meal URLi, while superior PPG control was demonstrated with mealtime dosing.
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Affiliation(s)
| | - Dachuang Cao
- Eli Lilly and Company, Lilly Corporate CenterIndianapolisIndianaUSA
| | - Mary Anne Dellva
- Eli Lilly and Company, Lilly Corporate CenterIndianapolisIndianaUSA
| | - Janet Tobian
- Eli Lilly and Company, Lilly Corporate CenterIndianapolisIndianaUSA
| | - Junnosuke Miura
- Tokyo Women's Medical University School of MedicineTokyoJapan
| | - Dominik Dahl
- Gemeinschaftspraxis fur Innere Medizin und DiabetologieHamburgGermany
| | - Jean Lucas
- Lucas ResearchMorehead CityNorth CarolinaUSA
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18
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Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management
of Type 2 Diabetes Mellitus 2020. Int J Diabetes Dev Ctries 2020. [PMCID: PMC7371966 DOI: 10.1007/s13410-020-00819-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology & Metabolism, UCMS-GTB Hospital, Delhi, India
| | - B. M. Makkar
- Dr Makkar’s Diabetes & Obesity Centre Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana India
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19
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Heller SR, Peyrot M, Oates SK, Taylor AD. Hypoglycemia in patient with type 2 diabetes treated with insulin: it can happen. BMJ Open Diabetes Res Care 2020; 8:8/1/e001194. [PMID: 32546549 PMCID: PMC7299018 DOI: 10.1136/bmjdrc-2020-001194] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/29/2020] [Accepted: 05/09/2020] [Indexed: 02/06/2023] Open
Abstract
There are many misconceptions about the prevalence and effects of hypoglycemia in people with type 2 diabetes (T2D), including hypoglycemia does not occur or does not have adverse consequences in T2D. This narrative review aims to help dispel these myths. Around 25% of people with T2D taking insulin for >5 years were found to have severe hypoglycemic events, which is comparable to the severe hypoglycemia rate in adults with type 1 diabetes (T1D) diagnosed within 5 years. The total number of hypoglycemic events among insulin-treated T2D, including severe hypoglycemia, is as high or higher than among those with T1D. Recent evidence suggests serious consequences of hypoglycemia may, in some respects, be greater in individuals with T2D, particularly regarding effects on the cardiovascular system. Hypoglycemia is generally patient-reported. Issues with hypoglycemia unawareness, limited glucose testing, limited recall, lack of event logging and fear of failure or shaming limits the number of hypoglycemic episodes reported by people with diabetes. Barriers to healthcare provider inquiry and reporting include lack of knowledge regarding the problem's magnitude, competing priorities during patient visits, lack of incentives to report and limitations to documentation systems for adequate reporting. All people with diabetes should be encouraged to discuss their experiences with hypoglycemia without judgment or shame. Glucose targets, testing schedules (blood glucose or continuous glucose monitoring) and treatment plans should be reviewed often and individualized to the minimize risk of hypoglycemia. Finally, people with T2D on insulin should always be encouraged to have oral glucose and rescue medication immediately available.
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Affiliation(s)
- Simon R Heller
- Endocrinology & Metabolism, University of Sheffield, Sheffield, UK
| | - Mark Peyrot
- Sociology, Loyola University Maryland, Baltimore, Maryland, USA
| | - Shannon K Oates
- Endocrinology & Metabolism, Indiana University Health Arnett Hospital, Lafayette, Indiana, USA
| | - April D Taylor
- Medical Development, Lilly USA, Indianapolis, Indiana, USA
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20
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Yoshino S, Yamada E, Okada S, Nakajima Y, Shibusawa R, Uehara R, Matsumoto S, Horiguchi K, Ishida E, Saito T, Yamada M. Assessment of factors that determine the mean absolute relative difference in flash glucose monitoring with reference to plasma glucose levels in Japanese subjects without diabetes. Endocr J 2020; 67:537-544. [PMID: 32023588 DOI: 10.1507/endocrj.ej19-0488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Abbott FreeStyle Libre flash glucose monitoring system (FGM) is a recently introduced, but widespread continuous glucose monitoring system. While its mean absolute relative difference (MARD) value indicating its accuracy is acceptable with reference to the self-monitoring of blood glucose (SMBG) levels, few reports have examined the MARD in sensor glucose values of FGM (FGM-SG) with reference to plasma glucose (PG) levels and the factors determining it. We performed oral glucose tolerance tests (OGTTs) in 25 Japanese subjects without diabetes. Parkes error grid analyses showed that FGM-SG with either SMBG or PG levels as a reference met International Organization for Standardization criteria. The MARD in FGM-SG with reference to SMBG levels was 10.9 ± 4.1% during OGTTs. Surprisingly, the MARD in FGM-SG with reference to PG levels was 20.3 ± 10.3% during OGTTs, revealing a discrepancy in the accuracy of FGM-SG compared with that of PG levels; moreover, the MARD showed negative correlations with fasting blood sugar level, homeostasis model assessment insulin resistance index, and body mass index (BMI). Multiple regression analyses revealed that BMI contributed the most to the MARD when FGM-SG and PG level were compared, as lean individuals have a greater MARD regardless of glucose levels. Inaccurate FGM data could potentially increase the risk of inappropriate treatment; consideration of such factors is critical to ensure reliable FGM values.
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Affiliation(s)
- Satoshi Yoshino
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Eijiro Yamada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Shuichi Okada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Yasuyo Nakajima
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Ryo Shibusawa
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Ryota Uehara
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Shunichi Matsumoto
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Kazuhiko Horiguchi
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Emi Ishida
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Tsugumichi Saito
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Masanobu Yamada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan
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21
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Katz LB, Stewart L, Guthrie B, Cameron H. Patient Satisfaction With a New, High Accuracy Blood Glucose Meter That Provides Personalized Guidance, Insight, and Encouragement. J Diabetes Sci Technol 2020; 14:318-323. [PMID: 31375031 PMCID: PMC7196872 DOI: 10.1177/1932296819867396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Accurate self-monitoring of blood glucose (SMBG) is a key component of effective self-management of glycemic control. METHODS The OneTouch Verio Reflect and OneTouch Ultra Plus Reflect BG monitoring systems were evaluated for accuracy in a clinical setting. Subjects also used the meters for a one-week trial period and reported their level of satisfaction with meter features. RESULTS Both systems were accurate over a wide glucose range and met lay user and system accuracy BG standards described in ISO15197:2015. Subjects felt that the features of a meter with a dynamic color range indicator and personalized guidance, insight, and encouragement could provide significant benefits to them in the management of their diabetes. CONCLUSIONS Both meter systems were accurate over a wide glucose range and the features of the meter and messages were well received by patients in a short take-home trial. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT0351542.
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Affiliation(s)
- Laurence B. Katz
- LifeScan Global Corp., Wayne, PA,
USA
- LifeScan Inc., Malvern, PA, USA
- Laurence B. Katz, PhD, LifeScan Inc., 20
Valley Stream Parkway, Malvern, PA 19355, USA.
| | - Lorna Stewart
- LifeScan Global Corp., Inverness,
UK
- LifeScan Scotland Ltd., Inverness,
UK
| | - Brian Guthrie
- LifeScan Global Corp., Inverness,
UK
- LifeScan Scotland Ltd., Inverness,
UK
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Desrochers HR, Schultz AT, Laffel LM. Use of Diabetes Technology in Children: Role of Structured Education for Young People with Diabetes and Families. Endocrinol Metab Clin North Am 2020; 49:19-35. [PMID: 31980118 PMCID: PMC7140592 DOI: 10.1016/j.ecl.2019.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The current era has witnessed an explosion of advanced diabetes technologies. Young people with diabetes and their families require detailed, structured diabetes education in order to optimize use of such devices. There is need for youth and their families to participate in the selection of particular devices for personal use and comprehensive education regarding the safe and effective use of such technologies. The education process should ensure that youth and their families receive realistic expectations of what the advanced technologies can and cannot do to avoid disappointment and the premature discontinuation of such systems.
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Affiliation(s)
- Hannah R Desrochers
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA
| | - Alan T Schultz
- Emergency Department, Montefiore Medical Center, 111 East 210th Street, The Bronx, NY 10467, USA
| | - Lori M Laffel
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA.
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23
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Kravarusic J, Aleppo G. Diabetes Technology Use in Adults with Type 1 and Type 2 Diabetes. Endocrinol Metab Clin North Am 2020; 49:37-55. [PMID: 31980120 DOI: 10.1016/j.ecl.2019.10.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the last 2 decades, diabetes technology has emerged as a branch of diabetes management thanks to the advent of continuous glucose monitoring (CGM) and increased availability of continuous subcutaneous insulin infusion systems, or insulin pumps. These tools have progressed from rudimentary instruments to sophisticated therapeutic options for advanced diabetes management. This article discusses the available CGM and insulin pump systems and the clinical benefits of their use in adults with type 1 diabetes, intensively insulin-treated type 2 diabetes, and pregnant patients with preexisting diabetes.
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Affiliation(s)
- Jelena Kravarusic
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, Suite 530, Chicago, IL 60611, USA
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, Suite 530, Chicago, IL 60611, USA.
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24
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Garber AJ, Handelsman Y, Grunberger G, Einhorn D, Abrahamson MJ, Barzilay JI, Blonde L, Bush MA, DeFronzo RA, Garber JR, Garvey WT, Hirsch IB, Jellinger PS, McGill JB, Mechanick JI, Perreault L, Rosenblit PD, Samson S, Umpierrez GE. CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM - 2020 EXECUTIVE SUMMARY. Endocr Pract 2020; 26:107-139. [PMID: 32022600 DOI: 10.4158/cs-2019-0472] [Citation(s) in RCA: 342] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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25
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Stone JY, Bailey TS. Benefits and limitations of continuous glucose monitoring in type 1 diabetes. Expert Rev Endocrinol Metab 2020; 15:41-49. [PMID: 31928104 DOI: 10.1080/17446651.2020.1706482] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/16/2019] [Indexed: 12/14/2022]
Abstract
Introduction: Type 1 diabetes (T1D) is a chronic condition characterized by a complete deficiency in insulin production. Optimal management requires constant knowledge of glucose levels for safe and effective insulin administration. Self-monitoring of blood glucose (SMBG) using capillary blood glucose meters is cumbersome and provides limited information to guide management. Continuous glucose monitoring (CGM) technology addresses many of these gaps, but itself has limitations which have prevented people with diabetes and their clinicians from fully embracing this technology. This review covers the benefits and limitations of CGM use, and looks toward future application of this technology in the management of T1D.Areas covered: Impact of CGM on physical and psychosocial outcomes in people with T1D. Barriers to CGM uptake. Integration with insulin pumps and other technologies. Opportunities for future application.Expert opinion: CGM technology will be utilized by the majority of people with T1D and increasing numbers of people with type 2 diabetes due to improved insurance coverage and easier-to-use systems. Its use as part of artificial pancreas systems will add further utility, as it will help to protect from both hypoglycemia and hyperglycemia. People with diabetes will spend more time in range and experience fewer acute and chronic complications.
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Affiliation(s)
- Jenine Y Stone
- AMCR Institute, Escondido, CA, USA
- Vanderbilt University School of Nursing, Nashville, TN, USA
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Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2020. Indian J Endocrinol Metab 2020; 24:1-122. [PMID: 32699774 PMCID: PMC7328526 DOI: 10.4103/ijem.ijem_225_20] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology and Metabolism, UCMS-GTB Hospital, New Delhi, India
| | - B. M. Makkar
- Dr. Makkar's Diabetes and Obesity Centre, Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, Gujarat, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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Otto Mattsson T, Lindhart CL, Schöley J, Friis‐Hansen L, Herrstedt J. Patient self‐testing of white blood cell count and differentiation: A study of feasibility and measurement performance in a population of Danish cancer patients. Eur J Cancer Care (Engl) 2019; 29:e13189. [DOI: 10.1111/ecc.13189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 05/26/2019] [Accepted: 10/24/2019] [Indexed: 12/26/2022]
Affiliation(s)
| | | | - Jonas Schöley
- Department of Public Health University of Southern Denmark Odense Denmark
| | | | - Jørn Herrstedt
- Department of Clinical Oncology Zealand University Hospital Roskilde Denmark
- University of Copenhagen Copenhagen Denmark
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Bao Y, Chen L, Chen L, Dou J, Gao Z, Gao L, Guo L, Guo X, Ji L, Ji Q, Jia W, Kuang H, Li Q, Li Q, Li X, Li Y, Li L, Liu J, Ma J, Ran X, Shi L, Song G, Wang Y, Weng J, Xiao X, Xie Y, Xi G, Yang L, Zhao Z, Zhou J, Zhou Z, Zhu D, Zou D. Chinese clinical guidelines for continuous glucose monitoring (2018 edition). Diabetes Metab Res Rev 2019; 35:e3152. [PMID: 30884108 DOI: 10.1002/dmrr.3152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/22/2019] [Accepted: 02/19/2019] [Indexed: 02/05/2023]
Abstract
Blood glucose monitoring is an important part of diabetes management. Continuous glucose monitoring (CGM) technology has become an effective complement to conventional blood glucose monitoring methods and has been widely applied in clinical practice. The indications for its use, the accuracy of the generated data, the interpretation of the CGM results, and the application of the results must be standardized. In December 2009, the Chinese Diabetes Society (CDS) drafted and published the first Chinese Clinical Guideline for Continuous Glucose Monitoring (2009 edition), providing a basis for the standardization of CGM in clinical application. Based on the updates of international guidelines and the increasing evidence of domestic studies, it is necessary to revise the latest CGM guidelines in China so that the recent clinical evidence can be effectively translated into clinical benefit for diabetic patients. To this end, the CDS revised the Chinese Clinical Guideline for Continuous Glucose Monitoring (2012 Edition) based on the most recent evidence from international and domestic studies.
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Affiliation(s)
- Yuqian Bao
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Li Chen
- Qilu Hospital of Shandong University, Jinan City, Shandong Province, China
| | - Liming Chen
- Tianjin Medical University Metabolic Disease Hospital, Tianjin, China
| | - Jingtao Dou
- Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhengnan Gao
- Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Leili Gao
- Peking University People's Hospital, Beijing, China
| | - Lixin Guo
- Beijing Hospital of the Ministry of Health, Beijing, China
| | - Xiaohui Guo
- Peking University First Hospital, Beijing, China
| | - Linong Ji
- Peking University People's Hospital, Beijing, China
| | - Qiuhe Ji
- Xijing Hospital of the Fourth Military Medical University, Xi'an City, Shanxi Province, China
| | - Weiping Jia
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hongyu Kuang
- The First Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Qifu Li
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiang Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Xiaoying Li
- Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yanbing Li
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Ling Li
- Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Jing Liu
- Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Jianhua Ma
- Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing City, Jiangsu Province, China
| | - Xingwu Ran
- West China Hospital of Sichuan University, Chengdu City, Sichuan Province, China
| | - Lixin Shi
- The Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, China
| | - Guangyao Song
- Hebei General Hospital, Shijiazhuang City, Hebei Province, China
| | - Yufei Wang
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianping Weng
- The First Affiliated Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei City, Anhui Province, China
| | - Xinhua Xiao
- Peking Union Medical College Hospital, Beijing, China
| | - Yun Xie
- Tianjin Medical University Metabolic Disease Hospital, Tianjin, China
| | - Guangxia Xi
- Shanxi Dayi Hospital, Taiyuan City, Shanxi Province, China
| | - Liyong Yang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, China
| | - Zhigang Zhao
- Zhengzhou Yihe Hospital Affiliated to Henan University, Zhengzhou City, Henan Province, China
| | - Jian Zhou
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhiguang Zhou
- The Second Xiangya Hospital of Central South University, Changsha City, Hunan Province, China
| | - Dalong Zhu
- Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing City, Jiangsu Province, China
| | - Dajin Zou
- Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China
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Yi WM, Van Wieren Jones EM, Hansen BK, Vora J. The Impact of Self-Monitoring Blood Glucose Adherence On Glycemic Goal Attainment in an Indigent Population, With Pharmacy Assistance. P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2019; 44:554-559. [PMID: 31485151 PMCID: PMC6705474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Self-monitoring of bood glucose alone is not a good predictor of HbA1c goal attainment. Health plans might benefit from formulary restrictions to provide more cost-effective care, without negatively impacting glycemic control. And by using targeted inteventions, healthcare providers could help maximize SMBG's clinical benefit for patients who receive test strips. Self-monitoring of blood glucose (SMBG) can be an important tool in diabetes treatment, both for patient self-management and for guiding clinicians regarding medication adjustments. Evidence supports the association of SMBG with clinical outcomes in patients with type-1 diabetes mellitus (T1DM) although it is mixed for patients with type-2 diabetes mellitus (T2DM). The cost of SMBG comprises a substantial portion of the total cost for patients with diabetes, and test strips are one of the main expenditures of the University of North Carolina Medical Center Pharmacy Assistance Program (PAP), which provides medication coverage, including test strips, to indigent patients who have no pharmacy insurance. The objective of this study is to evaluate the utility of SMBG based on the impact of test-strip adherence on glycemic goal attainment in an indigent population that is provided with low-copay test strips. This retrospective cohort study included patients with T1DM or T2DM who were enrolled in PAP in 2016 and who received a prescription for test strips during the 90 days prior to hemoglobin A1c (HbA1c) measurement. Adherence was defined as the proportion of days covered (PDC) > 0.8. Of the 498 patients encountered, 20% of the adherent group (n = 245) and 25% of the nonadherent group (n = 253) had a goal of HbA1c < 7% (P = 0.24). There were no differences in mean HbA1c between the groups, except in the multiple daily injections (MDI) of the insulin subgroup (8.9% vs. 9.6%, P = 0.009). The adherent group was 80% less likely to have a diabetes-related hospitalization (odds ratio [OR], 0.2; 95% CI, 0.04-0.92). The total test-strip cost to PAP was more than $200,000. In conclusion, in an indigent population, adherence to SMBG does not correlate with glycemic goal attainment and imposes a substantial cost burden on the healthcare system.
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Gazal G. Management of an emergency tooth extraction in diabetic patients on the dental chair. Saudi Dent J 2019; 32:1-6. [PMID: 31920272 PMCID: PMC6950840 DOI: 10.1016/j.sdentj.2019.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/04/2019] [Accepted: 07/27/2019] [Indexed: 02/08/2023] Open
Abstract
Background and objective Approximately 75% of diabetic patients in Saudi Arabia had poor glycaemic control. A high proportion of these patients will attend dental surgery clinics for treatment. Therefore, dentists should be well-prepared to control any complications they might arise on the dental chair during the dental procedures. Management of the associated risk factors is important to limit disease complications and improve the health of patients with diabetes.The objectives of this review were to determine the maximum acceptable level of blood glucose for tooth removal in diabetics, show a systematic technique for the management of patients with diabetes on the dental chair. By using PRISMA guidelines, analysis of the published articles and reports across the world is considered one of the most appropriate available methods to obtain strong evidence about the acceptable levels of blood glucose where teeth extraction can be done safely. Results A total of 1080 studies were retrieved using the search strategy. After screening 185 titles, abstracts and 85 full-text articles, 36 studies were included. The outcome of this systematic review revealed that fasting blood glucose level of 240 mg/dl is a critical point for any dental treatment because the warning signs of diabetes start coming out. Maximum acceptable levels of blood glucose for removal of teeth in diabetics are 180 mg/dl (before meal) and 234 mg/dl (2 h after a meal). High blood glucose levels reduce the secretion of nitric oxide (powerful vasodilator) in the body which leads to poor circulation and slow-healing socket. Uncontrolled diabetics are at high risk of infection because of the high ketone levels in the blood. Conclusion Fasting blood glucose level of 180 mg/dl is a cut-off point for any selective dental extraction. However, Random blood glucose level of 234 mg/dl (13 mmol/l) is a cut-off point for an emergency tooth extraction. Tightly controlled diabetic patients (blood glucose level below 70 mg/dl) are susceptible to hypoglycemia.
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Cappon G, Vettoretti M, Sparacino G, Facchinetti A. Continuous Glucose Monitoring Sensors for Diabetes Management: A Review of Technologies and Applications. Diabetes Metab J 2019; 43:383-397. [PMID: 31441246 PMCID: PMC6712232 DOI: 10.4093/dmj.2019.0121] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/10/2019] [Indexed: 01/21/2023] Open
Abstract
By providing blood glucose (BG) concentration measurements in an almost continuous-time fashion for several consecutive days, wearable minimally-invasive continuous glucose monitoring (CGM) sensors are revolutionizing diabetes management, and are becoming an increasingly adopted technology especially for diabetic individuals requiring insulin administrations. Indeed, by providing glucose real-time insights of BG dynamics and trend, and being equipped with visual and acoustic alarms for hypo- and hyperglycemia, CGM devices have been proved to improve safety and effectiveness of diabetes therapy, reduce hypoglycemia incidence and duration, and decrease glycemic variability. Furthermore, the real-time availability of BG values has been stimulating the realization of new tools to provide patients with decision support to improve insulin dosage tuning and infusion. The aim of this paper is to offer an overview of current literature and future possible developments regarding CGM technologies and applications. In particular, first, we outline the technological evolution of CGM devices through the last 20 years. Then, we discuss about the current use of CGM sensors from patients affected by diabetes, and, we report some works proving the beneficial impact provided by the adoption of CGM. Finally, we review some recent advanced applications for diabetes treatment based on CGM sensors.
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Affiliation(s)
- Giacomo Cappon
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Martina Vettoretti
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giovanni Sparacino
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Andrea Facchinetti
- Department of Information Engineering, University of Padova, Padova, Italy.
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Mian Z, Hermayer KL, Jenkins A. Continuous Glucose Monitoring: Review of an Innovation in Diabetes Management. Am J Med Sci 2019; 358:332-339. [PMID: 31402042 DOI: 10.1016/j.amjms.2019.07.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/23/2019] [Accepted: 07/15/2019] [Indexed: 11/18/2022]
Abstract
Most continuous glucose monitors (CGM) provide interstitial fluid glucose trends, which reflect blood glucose trends with alarms and alerts to prevent hypoglycemia and provide better glycemic control. CGM used in conjunction with insulin pumps has changed the management of patients with insulin-dependent diabetes, mainly type 1 diabetes. CGM technology prevents the need for frequent blood glucose testing, which is often cumbersome for patients, providing them with a better alternative. CGM technology is underprescribed and therefore advantage should be taken of this technology to provide better hemoglobin A1c (HbA1c) control and decrease incidence of diabetic complications. CGM is particularly useful in patients with hypoglycemia unawareness and nocturnal hypoglycemia. CGM is currently not approved in pregnant patients, in critically ill patients and patients on dialysis. Research suggests that the benefits certainly outweigh the limitations of this technology. This review article focuses on the technical and clinical use of continuous glucose monitoring and sensor-integrated pump technology.
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Affiliation(s)
- Zainab Mian
- Division of Endocrinology, Diabetes and Metabolic Diseases, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson Veteran Affairs Medical Center, Charleston, South Carolina
| | - Kathie L Hermayer
- Division of Endocrinology, Diabetes and Metabolic Diseases, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson Veteran Affairs Medical Center, Charleston, South Carolina.
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
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Horton WB, Law S, Darji M, Conaway MR, Kubiak NT, Kirby JL, Thigpen SC. Construction and preliminary evaluation of the inpatient glycemic control questionnaire (IGCQ): a survey tool assessing perceptions and knowledge of resident physicians. BMC MEDICAL EDUCATION 2019; 19:228. [PMID: 31234836 PMCID: PMC6591905 DOI: 10.1186/s12909-019-1657-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 06/06/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Uncontrolled hyperglycemia in hospitalized patients, with or without diabetes mellitus, is associated with many adverse outcomes. Resident physicians are the primary managers of inpatient glycemic control (IGC) in many academic and community medical centers; however, no validated survey tools related to their perceptions and knowledge of IGC are currently available. As identification of common barriers to successful IGC amongst resident physicians may help foster better educational interventions (ultimately leading to improvements in IGC and patient care), we sought to construct and preliminarily evaluate such a survey tool. METHODS We developed the IGC questionnaire (IGCQ) by using previously published but unvalidated survey tools related to physician perspectives on inpatient glycemic control as a framework. We administered the IGCQ to a cohort of resident physicians from the University of Mississippi Medical Center, University of Louisville, Emory University, and the University of Virginia. We then used classical test theory and Rasch Partial Credit Model analyses to preliminarily evaluate and revise the IGCQ. The final survey tool contains 16 total items and three answer-choice categories for most items. RESULTS Two hundred forty-six of 438 (56.2%) eligible resident physicians completed the IGCQ during various phases of development. CONCLUSIONS We constructed and preliminarily evaluated the IGCQ, a survey tool that may be useful for future research into resident physician perceptions and knowledge of IGC. Future studies could seek to externally validate the IGCQ and then utilize the survey tool in pre- and post-intervention assessments.
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Affiliation(s)
- William B. Horton
- Divsion of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA USA
| | - Sidney Law
- Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Monika Darji
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Chicago, Chicago, IL USA
| | - Mark R. Conaway
- Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA USA
| | - Nancy T. Kubiak
- Division of General Internal Medicine, Palliative Medicine, and Medical Education, Department of Medicine, University of Louisville, Louisville, KY USA
| | - Jennifer L. Kirby
- Divsion of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA USA
| | - S. Calvin Thigpen
- Division of General Internal Medicine and Hypertension, Department of Medicine, University of Mississippi Medical Center, Jackson, MS USA
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Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, Dagogo-Jack S, DeFronzo RA, Einhorn D, Fonseca VA, Garber JR, Garvey WT, Grunberger G, Handelsman Y, Hirsch IB, Jellinger PS, McGill JB, Mechanick JI, Rosenblit PD, Umpierrez GE. CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM - 2019 EXECUTIVE SUMMARY. Endocr Pract 2019; 25:69-100. [PMID: 30742570 DOI: 10.4158/cs-2018-0535] [Citation(s) in RCA: 203] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Slugocki M, Bialonczyk D, Özdener AE. A Review of Emerging Technologies in Diabetes Management for Multiple-Dose Insulin-Injecting Patients With Type 2 Diabetes Who Self-monitor Blood Glucose. J Pharm Technol 2019; 35:69-81. [DOI: 10.1177/8755122518813889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: The management of diabetes mellitus requires a precise interpretation of blood glucose (BG) data by patients and providers and is increasingly associated with a need for medical technologies that aid in achieving patient-specific outcomes while making the process convenient. This review aims to summarize the current landscape in diabetes management technology, focusing specifically on devices that assist with pattern management in patients with type 2 diabetes (T2DM) who are on multiple-dose insulin regimens. Data Sources: The authors searched MEDLINE to identify articles from 2007 to 2018 that evaluated technologies for BG pattern management and diabetes monitoring. Additional references were generated through review of identified literature citations. Article selection was based on mutual agreement for inclusion. Data Selection and Data Extraction: Relevant articles were defined as English-language articles, describing technologies that assist with diabetes management in insulin-injecting patients with T2DM. Articles that focused exclusively on type 1 diabetes were excluded. Data Synthesis: The literature search yielded 334 articles, of which 21 were included for synthesis. The current BG monitoring practices emphasize the benefit of the structured self-monitoring of BG approach. Several randomized controlled trials conclude that the available technology aids in comprehensive data collection and facilitates communication between patients and providers. Digitally enabled “smart” devices are valuable tools that may help improve outcomes while providing a flexible, personalized approach. Conclusions: Integration of digital technology with diabetes management allows for accurate collection and analysis of data. Emergence of digital tools promotes a comprehensive, precise, and objective approach to glucose monitoring and encourages patient-provider collaborations.
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Van Dril E, Schumacher C. Impact of professional continuous glucose monitoring by clinical pharmacists in an ambulatory care setting. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1088] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Elizabeth Van Dril
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy; Chicago Illinois
| | - Christie Schumacher
- Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy; Chicago Illinois
- Advocate Medical Group-Southeast; Chicago Illinois
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Ajjan R, Slattery D, Wright E. Continuous Glucose Monitoring: A Brief Review for Primary Care Practitioners. Adv Ther 2019; 36:579-596. [PMID: 30659511 PMCID: PMC6824352 DOI: 10.1007/s12325-019-0870-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Indexed: 12/17/2022]
Abstract
Glycated hemoglobin A1c (HbA1c) is routinely used as a marker of average glycemic control, but it fails to provide data on hypoglycemia and glycemic variability, both of which are associated with adverse clinical outcomes. Self-monitoring of blood glucose (SMBG), particularly in insulin-treated patients, is a cornerstone in the management of patients with diabetes. SMBG helps with treatment decisions that aim to reduce high glucose levels while avoiding hypoglycemia and limiting glucose variability. However, repeated SMBG can be inconvenient to patients and difficult to maintain in the long term. By contrast, continuous glucose monitoring (CGM) provides a convenient, comprehensive assessment of blood glucose levels, allowing the identification of high and low glucose levels, in addition to evaluating glycemic variability. CGM using newer detection and visualization systems can overcome many of the limitations of an HbA1c-based approach while addressing the inconvenience and fragmented glucose data associated with SMBG. When used together with HbA1c monitoring, CGM provides complementary information on glucose levels, thus facilitating the optimization of diabetes therapy while reducing the fear and risk of hypoglycemia. Here we review the capabilities and benefits of CGM, including cost-effectiveness data, and discuss the potential limitations of this glucose-monitoring strategy for the management of patients with diabetes. FUNDING: Sanofi US, Inc.
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Affiliation(s)
- Ramzi Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, The LIGHT Laboratories, University of Leeds, Leeds, UK.
| | - David Slattery
- Endocrinology and Metabolic Medicine, York Teaching Hospital, NHS Foundation Trust, York, UK
| | - Eugene Wright
- Department of Medicine and Community and Family Medicine, Duke Southern Regional AHEC, Fayetteville, NC, USA
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Heller S, Meneghini L, Nikolajsen A, Kragh N, Lewis HB, Saretsky T, Kosmas CE, Lloyd A. Towards a better understanding of postprandial hyperglycemic episodes in people with diabetes: impact on daily functioning. Curr Med Res Opin 2019; 35:525-533. [PMID: 30221550 DOI: 10.1080/03007995.2018.1525344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Acute postprandial hyperglycemia (aPPHG) is often symptomatic and can be associated with behavioral changes such as impaired working memory and attention. However, there is little evidence of the impact of aPPHG on the daily lives of patients. The aim of this study was to explore the frequency and severity of aPPHG episodes and their impact on daily functioning in people with insulin-treated diabetes. METHODS Adults (n = 1200) with insulin-treated diabetes mellitus type 1 (T1DM) or 2 (T2DM), most of whom experienced aPPHG, were recruited to complete an online cross-sectional survey in the USA and UK. The survey captured self-reported severity and frequency of aPPHG episodes and included a newly developed questionnaire (aPPHG-Q) assessing the impact of aPPHG episodes on patients' daily lives. Data was analyzed separately according to diabetes type and country. Regression analyses were used to assess the relationship between severity or frequency and scores on the aPPHG-Q. RESULTS Between 70% and 86% of USA, and 87% and 88% of UK participants reported experiencing aPPHG episodes. Increasing frequency and severity of aPPHG episodes were associated with worse scores on the aPPHG-Q in patients with both T1DM and T2DM in both countries (p < .014) on all subscale scores (excluding the worry and concerns scores for T1DM in the UK), although the magnitude of the association was smaller for aPPHG frequency. CONCLUSIONS Increased severity and frequency of aPPHG episodes in patients with insulin-treated diabetes is associated with greater burden and experience of symptoms, and can negatively impact daily functioning.
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Affiliation(s)
- Simon Heller
- a Department of Oncology & Metabolism, University of Sheffield , Sheffield , United Kingdom
| | - Luigi Meneghini
- b Southwestern Medical Center and Parkland Health & Hospital System, University of Texas , Dallas , Texas
| | | | | | | | | | | | - Andrew Lloyd
- g Acaster Lloyd Consulting Ltd , London , United Kingdom
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Midyett K, Unger JR, Wright EE, Daniel TD, Kruger DF, Henry RR, Hegazi RA. A Pilot Study to Assess Clinical Utility and User Experience of Professional Continuous Glucose Monitoring Among People With Type 2 Diabetes. Clin Diabetes 2019; 37:57-64. [PMID: 30705498 PMCID: PMC6336116 DOI: 10.2337/cd18-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IN BRIEF Glucose variability is a potential independent risk factor of poor clinical outcome among people with diabetes, with adequate measurement technically difficult and cumbersome. For this study, a novel 14-day continuous sensor was used to assess glucose variability among people with type 2 diabetes (T2D). The aim was to characterize glucose profiles for up to 2 weeks in T2D and to survey device utilization in a standard clinical setting and its potential to collect clinically meaningful data.
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Affiliation(s)
- Kurt Midyett
- Midwest Women’s & Children’s Specialty Group, Overland Park, KS
| | - Jeffrey R. Unger
- Unger Primary Care Medical Center and Catalina Research Institute, Chino, CA
| | - Eugene E. Wright
- Duke Southern Regional Area Health Education Center, Fayetteville, NC
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40
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Campbell FM, Murphy NP, Stewart C, Biester T, Kordonouri O. Outcomes of using flash glucose monitoring technology by children and young people with type 1 diabetes in a single arm study. Pediatr Diabetes 2018; 19:1294-1301. [PMID: 30054967 DOI: 10.1111/pedi.12735] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 06/11/2018] [Accepted: 07/02/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Outcomes of using flash glucose monitoring have been reported in adults. This trial evaluated use in children and teenagers with type 1 diabetes. METHODS Prospective, single arm, non-inferiority multicenter study to demonstrate equivalence of time in range (TIR [70-180 mg/dL]) by comparing 14-day masked sensor wear (baseline) with self-monitored blood glucose (SMBG) testing to the final 14-days of 8-week open-label system use for diabetes self-management including insulin dosing. RESULTS A total of 76 children and teenagers (46.1% male; age 10.3 ± 4.0 years, type 1 diabetes duration 5.4 ± 3.7 years; mean ± SD) from 10 sites participated. TIR improved significantly by 0.9 ± 2.8 h/d (P = 0.005) vs SMBG baseline. Time in hyperglycemia (>180 mg/dL) reduced by -1.2 ± 3.3 h/d (P = 0.004). HbA1c reduced by -0.4% (-4.4 mmol/mol), from 7.9 ± 1.0% (62.9 ± 11.2 mmol/mol) baseline to 7.5 ± 0.9% (58.5 ± 9.8 mmol/mol) study end (P < 0.0001) with reductions across all age-subgroups (4-6, 7-12 and 13-17 years). Time in hypoglycemia (<70 mg/dL) was unaffected. Throughout the treatment phase system utilization was 91% ± 9; sensor scanning was 12.9 ± 5.7/d with SMBG dropping to 1.6 ± 1.9 from 7.7 ± 2.5/d. Diabetes Treatment Satisfaction Questionnaire "Total Treatment Satisfaction" score improved for parents (P < 0.0001) and teenagers (P < 0.0001). No adverse events (n = 121) were associated with sensor accuracy, 42 participants experienced sensor insertion signs and symptoms. Three participants experienced three mild device-related (sensor wear) symptoms, resolving quickly (without treatment [n = 2], non-prescription antihistamines [n = 1]). CONCLUSIONS Children with diabetes improved glycemic control safely and effectively with short-term flash glucose monitoring compared to use of SMBG in a single arm study.
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Affiliation(s)
- Fiona M Campbell
- Children's Diabetes Centre, Leeds Children's Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - Nuala P Murphy
- Department of Paediatric Endocrinology, Children's University Hospital, Dublin, Republic of Ireland
| | | | - Torben Biester
- Diabetes Center for Children and Adolescents, Children's Hospital Auf der Bult, Hannover, Germany
| | - Olga Kordonouri
- Diabetes Center for Children and Adolescents, Children's Hospital Auf der Bult, Hannover, Germany
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41
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Wood A, O'Neal D, Furler J, Ekinci EI. Continuous glucose monitoring: a review of the evidence, opportunities for future use and ongoing challenges. Intern Med J 2018; 48:499-508. [PMID: 29464891 DOI: 10.1111/imj.13770] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/20/2018] [Accepted: 01/29/2018] [Indexed: 12/14/2022]
Abstract
The advent of devices that can track interstitial glucose levels, which are closely related to blood glucose levels, on a near continuous basis, has facilitated better insights into patterns of glycaemia. Continuous glucose monitoring (CGM) therefore allows for more intensive monitoring of blood glucose levels and potentially improved glycaemic control. In the context of the announcement on 1 April 2017 that the Australian Government will fund CGM monitoring for people with type 1 diabetes under the age of 21 years, this paper provides a review of the evidence for CGM and some of the ongoing challenges. There is evidence that real-time CGM in type 1 diabetes improves HbA1c and hypoglycaemia, while in type 2 diabetes, the evidence is less robust. Initial barriers to widespread implementation of CGM included issues with accuracy and user friendliness; however, as the technology has evolved, these issues have largely improved. Ongoing barriers include cost, and weaker evidence for their benefit in certain populations such as those with type 2 diabetes and less glycaemic variability. CGM has the potential to reduce healthcare costs, although real-world studies, including cost-effectiveness analyses, are needed in this area.
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Affiliation(s)
- Anna Wood
- Department of Endocrinology, Austin Health, Repatriation Campus Heidelberg West, Melbourne, Victoria, Australia
| | - David O'Neal
- Department of Medicine, St Vincent's Hospital and The University of Melbourne, Melbourne, Victoria, Australia
| | - John Furler
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elif I Ekinci
- Department of Endocrinology, Austin Health, Repatriation Campus Heidelberg West, Melbourne, Victoria, Australia.,Department of Medicine, Austin Health and The University of Melbourne (Austin Campus), Melbourne, Victoria, Australia
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Heinemann L, Stuhr A, Brown A, Freckmann G, Breton MD, Russell S, Heinemann L. Self-measurement of Blood Glucose and Continuous Glucose Monitoring - Is There Only One Future? EUROPEAN ENDOCRINOLOGY 2018; 14:24-29. [PMID: 30349591 PMCID: PMC6182926 DOI: 10.17925/ee.2018.14.2.24] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 06/29/2018] [Indexed: 01/13/2023]
Abstract
Monitoring glycaemic control in patients with diabetes has evolved dramatically over the past decades. The introduction of easy-to-use systems for self-monitoring of blood glucose (SMBG) utilising capillary blood samples has resulted in the availability of a wide range of systems, providing different measurement quality. Systems for continuous glucose monitoring (CGM) – used mainly in patients with type 1 diabetes (T1D) – were made possible by the development of glucose sensors that measure glucose levels in the interstitial fluid (ISF) in the subcutaneous tissue of the skin. CGM readings might not correspond exactly to SMBG measurement results taken at the same time, especially during rapid changes in either blood glucose or ISF glucose levels. The mean absolute relative difference is the most popular method used for characterising the measurement performance of CGM systems. Unlike the International Organization for Standardization 15197:2013 criteria for SMBG systems, no accuracy standards for CGM systems exist. Measurement quality of CGM systems can vary based on several factors, limiting their safety and effective use in managing diabetes. Patients have to be trained adequately to make safe and efficient use of CGM systems (like with SMBG systems). Also, systems for CGM must be evaluated in terms of patient safety and the ability to provide accurate measurements regardless of the fluctuation of glucose levels. As new technological advancements in glucose monitoring are essential for improved management options of diabetes, such as automated insulin dosing systems, there is a need for a critical view of all such developments. It is likely that both, SMBG and CGM systems, will play important future roles in the treatment of diabetes.
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Affiliation(s)
| | | | - Adam Brown
- Science Consulting in Diabetes GmbH, Neuss, Germany.,Ascensia Diabetes Care, NJ, US.,Head of Diabetes Technology and Digital Health Close Concerns, San Francisco, US.,MD, General Manager and Medical Director, Institute of Diabetes Technology Research and Development Company GmbH ULM University, Germany.,PhD, Associate Professor, Center for Diabetes Technologies, University of Virginia, US.,MD, PhD, Assistant Professor of Medicine, Massachusetts General Hospital, Diabetes Research Center, US.,CEO, Science Consulting in Diabetes GmbH, Germany
| | - Guido Freckmann
- Science Consulting in Diabetes GmbH, Neuss, Germany.,Ascensia Diabetes Care, NJ, US.,Head of Diabetes Technology and Digital Health Close Concerns, San Francisco, US.,MD, General Manager and Medical Director, Institute of Diabetes Technology Research and Development Company GmbH ULM University, Germany.,PhD, Associate Professor, Center for Diabetes Technologies, University of Virginia, US.,MD, PhD, Assistant Professor of Medicine, Massachusetts General Hospital, Diabetes Research Center, US.,CEO, Science Consulting in Diabetes GmbH, Germany
| | - Marc D Breton
- Science Consulting in Diabetes GmbH, Neuss, Germany.,Ascensia Diabetes Care, NJ, US.,Head of Diabetes Technology and Digital Health Close Concerns, San Francisco, US.,MD, General Manager and Medical Director, Institute of Diabetes Technology Research and Development Company GmbH ULM University, Germany.,PhD, Associate Professor, Center for Diabetes Technologies, University of Virginia, US.,MD, PhD, Assistant Professor of Medicine, Massachusetts General Hospital, Diabetes Research Center, US.,CEO, Science Consulting in Diabetes GmbH, Germany
| | - Steven Russell
- Science Consulting in Diabetes GmbH, Neuss, Germany.,Ascensia Diabetes Care, NJ, US.,Head of Diabetes Technology and Digital Health Close Concerns, San Francisco, US.,MD, General Manager and Medical Director, Institute of Diabetes Technology Research and Development Company GmbH ULM University, Germany.,PhD, Associate Professor, Center for Diabetes Technologies, University of Virginia, US.,MD, PhD, Assistant Professor of Medicine, Massachusetts General Hospital, Diabetes Research Center, US.,CEO, Science Consulting in Diabetes GmbH, Germany
| | - Lutz Heinemann
- Science Consulting in Diabetes GmbH, Neuss, Germany.,Ascensia Diabetes Care, NJ, US.,Head of Diabetes Technology and Digital Health Close Concerns, San Francisco, US.,MD, General Manager and Medical Director, Institute of Diabetes Technology Research and Development Company GmbH ULM University, Germany.,PhD, Associate Professor, Center for Diabetes Technologies, University of Virginia, US.,MD, PhD, Assistant Professor of Medicine, Massachusetts General Hospital, Diabetes Research Center, US.,CEO, Science Consulting in Diabetes GmbH, Germany
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RSSDI consensus on self-monitoring of blood glucose in types 1 and 2 diabetes mellitus in India. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0677-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Tauschmann M, Hovorka R. Technology in the management of type 1 diabetes mellitus - current status and future prospects. Nat Rev Endocrinol 2018; 14:464-475. [PMID: 29946127 DOI: 10.1038/s41574-018-0044-y] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Type 1 diabetes mellitus (T1DM) represents 5-10% of diabetes cases worldwide. The incidence of T1DM is increasing, and there is no immediate prospect of a cure. As such, lifelong management is required, the burden of which is being eased by novel treatment modalities, particularly from the field of diabetes technologies. Continuous glucose monitoring has become the standard of care and includes factory-calibrated subcutaneous glucose monitoring and long-term implantable glucose sensing. In addition, considerable progress has been made in technology-enabled glucose-responsive insulin delivery. The first hybrid insulin-only closed-loop system has been commercialized, and other closed-loop systems are under development, including dual-hormone glucose control systems. This Review focuses on well-established diabetes technologies, including glucose sensing, pen-based insulin delivery, data management and data analytics. We also cover insulin pump therapy, threshold-based suspend, predictive low-glucose suspend and single-hormone and dual-hormone closed-loop systems. Clinical practice recommendations for insulin pump therapy and continuous glucose monitoring are presented, and ongoing research and future prospects are highlighted. We conclude that the management of T1DM is improved by diabetes technology for the benefit of the majority of people with T1DM, their caregivers and guardians and health-care professionals treating patients with T1DM.
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Affiliation(s)
- Martin Tauschmann
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
- Department of Paediatrics, University of Cambridge, Cambridge, UK.
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Taylor PJ, Thompson CH, Brinkworth GD. Effectiveness and acceptability of continuous glucose monitoring for type 2 diabetes management: A narrative review. J Diabetes Investig 2018; 9:713-725. [PMID: 29380542 PMCID: PMC6031515 DOI: 10.1111/jdi.12807] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/07/2018] [Accepted: 01/21/2018] [Indexed: 01/05/2023] Open
Abstract
The present narrative review discusses the role of continuous glucose monitoring (CGM) in glycemic and weight control, and lifestyle behavior adherence in adults with type 2 diabetes. A literature search from January 2001 to November 2017 was carried out (MEDLINE, CINAHL, Web of Science and Scopus). Eligible studies were trials evaluating the use of CGM with the aim of achieving glucose control or lifestyle-related treatment adherence over a period of ≥8 weeks in adults with type 2 diabetes compared with usual care or another comparison intervention, or observational trials reporting CGM user experience. A total of 5,542 participants were recruited into 11 studies (eight randomized controlled trials [n = 5,346] and three observational studies [n = 196]). The sample size ranged 6-4,678 participants, the mean age was 51.7-60.0 years and diabetes duration was 2.1-19.2 years, with high heterogeneity between studies. Overall, the available evidence showed, compared with traditional self-monitoring of blood glucose levels, CGM promoted greater reductions in glycated hemoglobin, bodyweight and caloric intake; higher adherence rating to a personal eating plan; and increases in physical activity. High compliance to CGM wear-time and device calibration was reported (>90%). The addition of lifestyle and/or behavioral counseling to CGM appeared to further potentiate these improvements. Preliminary evidence suggests that CGM use promotes glycemic and weight control, and lifestyle behavior adherence in adults with type 2 diabetes. These benefits might be further enhanced with integration of diet, exercise, and glucose excursion education and counseling. However, specific attributes of effective interventions and the application of CGM information for promoting improved outcomes and healthier choices remain unclear.
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Affiliation(s)
- Pennie J Taylor
- CSIRO, Health and BiosecurityAdelaideSouth AustraliaAustralia
- Discipline of MedicineSchool of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Campbell H Thompson
- Discipline of MedicineSchool of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Abstract
Glycemic variability (GV) is a major consideration when evaluating quality of glycemic control. GV increases progressively from prediabetes through advanced T2D and is still higher in T1D. GV is correlated with risk of hypoglycemia. The most popular metrics for GV are the %Coefficient of Variation (%CV) and standard deviation (SD). The %CV is correlated with risk of hypoglycemia. Graphical display of glucose by date, time of day, and day of the week, and display of simplified glucose distributions showing % of time in several ranges, provide clinically useful indicators of GV. SD is highly correlated with most other measures of GV, including interquartile range, mean amplitude of glycemic excursion, mean of daily differences, and average daily risk range. Some metrics are sensitive to the frequency, periodicity, and complexity of glycemic fluctuations, including Fourier analysis, periodograms, frequency spectrum, multiscale entropy (MSE), and Glucose Variability Percentage (GVP). Fourier analysis indicates progressive changes from normal subjects to children and adults with T1D, and from prediabetes to T2D. The GVP identifies novel characteristics for children, adolescents, and adults with type 1 diabetes and for adults with type 2. GVP also demonstrated small rapid glycemic fluctuations in people with T1D when using a dual-hormone closed-loop control. MSE demonstrated systematic changes from normal subjects to people with T2D at various stages of duration, intensity of therapy, and quality of glycemic control. We describe new metrics to characterize postprandial excursions, day-to-day stability of glucose patterns, and systematic changes of patterns by day of the week. Metrics for GV should be interpreted in terms of percentiles and z-scores relative to identified reference populations. There is a need for large accessible databases for reference populations to provide a basis for automated interpretation of GV and other features of continuous glucose monitoring records.
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Affiliation(s)
- David Rodbard
- Biomedical Informatics Consultants LLC , Potomac, Maryland
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47
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Abstract
New therapies, monitoring, and revolutionary enabling technologies applied to healthcare represent an historic opportunity to improve the lives of people with diabetes. These advances enable more meaningful monitoring of blood glucose values with the facilitation of more optimal insulin dosing and delivery. Newer insulins and delivery systems are in development that seek to mitigate both hyperglycemia and hypoglycemia and increase time in range. Information systems now exist that may be leveraged to merge data from previously discrete systems into new models of connected care. This review highlights important developments that serve to increase effectiveness while reducing the burden of diabetes care in the near future.
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Affiliation(s)
| | - John Walsh
- 2 Advanced Metabolic Care + Research , Escondido, California
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Pardo S, Shaginian RM, Simmons DA. Accuracy Beyond ISO: Introducing a New Method for Distinguishing Differences Between Blood Glucose Monitoring Systems Meeting ISO 15197:2013 Accuracy Requirements. J Diabetes Sci Technol 2018; 12:650-656. [PMID: 29542346 PMCID: PMC6154250 DOI: 10.1177/1932296818762509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Diabetes treatment is intended to maintain near-normal glycemic levels. Self-monitoring of blood glucose (SMBG) allows patients to track their BG levels compared with glycemic targets and is associated with improved health outcomes. Because of the importance of SMBG, it is essential that results are accurate to prevent errors in nutritional intake and drug dosing. This study presents a new methodology to evaluate the accuracy of BG monitoring systems (BGMSs). METHODS Sensitivity analyses were performed using real and simulated BGMS data to compute probabilities that, for any BG value, the BGMS result would be within prescribed error bounds and confidence limits compared with laboratory reference values. Multiple BG value ranges were used. RESULTS Probability curves were created using data from 3 simulated BGMSs and anonymized data from 3 real-world BGMSs. Accuracy probability curves from capillary fingertip blood samples (actual clinical data) showed that all 3 real-world BGMSs met EN ISO 15197:2015 accuracy criteria, since 99.63%, 99.63%, and 99.81% of results from the 3 BGMSs were within ±15 mg/dL or ±15% of reference for BG <100 mg/dL and ≥100 mg/dL, respectively. However, there was identifiable variability between BGMSs if BG was <70 mg/dL; one BGMS showed further reductions in accuracy if BG was <50 mg/dL. CONCLUSIONS Probability curves highlight the importance of BGMS accuracy to help achieve optimal glycemic control while avoiding hypoglycemia or hyperglycemia. This may be especially significant in very low BG ranges where small errors in BGMS measurements can have substantial impacts on patient-related outcomes, including hypoglycemia risk.
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Abstract
PURPOSE OF REVIEW The purpose of this review was to synthesize the research on the experience of partners living with adults with type 1 diabetes (T1D). RECENT FINDINGS Eleven studies were included in the review. Three themes on the experience of living with a person with T1D were identified: the undercurrent of hypoglycemia, partners' involvement in diabetes care, and the impact on partners' lives. Due to considerable fear of hypoglycemia, partners had pervasive and deliberate ways in which they made attempts to minimize hypoglycemia in the person with diabetes and its cascade to a health emergency. As a result, partners of adults with T1D experienced considerable distress and disrupted lives. Partners also expressed a need for more support from family, friends, and health professionals. Research is needed on the partner experience across the lifespan and the specific supportive services they need in order to optimize their health outcomes.
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50
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Affiliation(s)
- Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, Colorado
- Address correspondence to:SaritPolsky, MD, MPHBarbara Davis Center for DiabetesUniversity of Colorado Denver1775 Aurora Court, MS A140Aurora, CO 80045
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